CAHD-ACDH The national voice of Canadian hospital-affiliated dentists cahd@cahd-acdh.ca

Renew membership

Membership renewal membership

Renew membership

Membership Renewal form

    Renewal Information

    Dr.

    To update/correct membership information, please make the necessary edits below.


    1. Application Information

    Name:

    Date of birth:

    Citizenship:

    2. Address Information

    Primary Office Address


    Province/State:

    Country:

    Office Phone: Office Fax:

    Home Address


    Province/State:

    Country:

    Home Phone: Cell:


    Preferred mailing address:OfficeHome

    3. Hospital and university appointments

    Are you a GP or specialist?GPSpecialist (specify)

    Have you completed a GPRAEGD Where?

    Present Hospital Appointments:

    Hospital name:
    Staff position:
    Date of appointment:

    Hospital name:
    Staff position:
    Date of appointment:

    Present Academic Appointments:

    Name of Faculty:
    Position:
    Date of appointment:

    Name of Faculty:
    Position:
    Date of appointment:

    I consent to have my name, position, affiliation and contact information included in a Membership Directory, available to members only, on a secure members page:
    YesNo

    May we correspond with you via email exclusively? YesNo

    Students/Residents Renewal form

      Renewal Information for Students & Residents

      Dr.

      To update/correct membership information, please make the necessary edits below.
      No editsYes, there are edits (see below)


      1. Application Information

      Name:

      Date of birth:

      Citizenship:

      2. Address Information

      Primary Office Address


      Province/State:

      Country:

      Office Phone: Office Fax:

      Home Address


      Province/State:

      Country:

      Home Phone: Cell:


      Preferred mailing address:OfficeHome
      May we correspond with you via email exclusively? YesNo

      3. Hospital and university appointments

      Current Program (check all that apply):

      Dental student: Dental Student Year:

      Resident: GPRSpecialty program

      Graduate Studies: MScPhDOther

      University: Date of appointment"



      I consent to have my name, position/affiliation and contact information included in a Membership Directory, available to members only, on a secure members page: YesNo

      May we correspond with you via email exclusively? YesNo