Affiliate Student

Students who are enrolled full time in an accredited graduate prosthodontic program at a university. A signed letter from program director required. The IJP is not included with dues.

No online or hard copy journal included. You may purchase Online and/or Hardcopy Journal Subscriptions during sign-up.

Membership Dues: $75.00

Honorific

First Name

Last Name

Job Title

Date of Birth

Other Organizational Memberships

Contact Information

Country

Address

City

State / Province
If you choose international/other, you can add your region into the city field, above.

Zip / Postal Code

Telephone Number (include country code)

Email Address

Affiliation Information

University / Institution / Affiliation / Private Practice

Department

Position / Title

Personal / Private Practice Website URL

Education Information

Undergraduate School Attended

Undergraduate Degree Completed on

Graduate School Attended

Graduate Degree Completed on

University / Program Attending

University / Program Department

University / Program Chairperson

Email address of University / Program Chairperson

University / Program Enrollment Date

University / Program Expected Graduation Date

Supporting Documentation

A signed letter from your program director is required.

References

How did you hear about the ICP?
A Member Referral
Colleague
ICP Meeting
ICP Web Site
ICP Webinar
International Journal of Prosthodontics (IJP)
Invitation
Journal Advertising (other than IJP)
Social Media
Other:

Membership Reference List one (1) ICP Constituent Member for reference

Reference First Name

Reference Last Name

Reference Email

Privacy Information

Do you consent to receive email communications from us, regarding your membership?
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Show in member directories?
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Who can view member details?
public members only administrators only

Membership Options

Years of Membership to Purchase

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