ICP New Member Application
    Fill out each tab below, clicking [Next >>] when completed, then click [Submit Application].

Member Overview / Summary
Contact Info Email Address needs to be updated:
Contact Info Mailing Address needs to be updated:
Contact Name:
Membership ID:
Contact Email Address:
Affiliation:
Membership Classification:
Current Amount Due: $
Make a Donation:
Contact information made available on ICP website:
Member Classification
Member Classification applying for *



Login Information
How did you hear about the ICP?
Username: *
Password: *
Confirm Password: *
Check the following box to make you information public on the ICP website (Find a Member).*
Contact Information
Title:
First Name/Given Name/Forename: *
Last/Surname/Family Name: *
Country: *
Address 1: *
Address 2:
Address 3:
Address 4:
City: *
State/Province/Region: *
Zip/Postal Code:
Telephone Number (include country code):
Email Address: *
Organization Information
Organization Name:
Acronym for Organization:
Organization's General/Public Email Address:
Organization's Website Address:
Does organization provide conferences for members?
Location of your next general meeting:
Website URL of your next general meeting:
Date of your next general meeting:
RadDatePicker
RadDatePicker
Open the calendar popup.
Organization is a: (Select all that apply)
National Organization:
International Organization:
Local/Provincial/State Organization:
Organization's membership include: (Select all that apply)
General Dentists:
Specialist Prosthodontists:
Other Specialist Groups:
Dental Hygienists:
Technologists:
Scientists:
Does organization provide certification or credentialing at any level?      
Is organization certified or registered as a continuing education provider?      
IJP Information. Complete this address for IJP delivery.
Mail Address
Same as Contact Information?
Country:
Address 1:
Address 2:
Address 3:
Address 4:
City:
State/Province/Region:
Zip/Postal Code:
Journal Request History
to change your mailing address on an existing order below, click 'Edit Address' which will load the address above. Then click 'Save Updated IJP Address'
Affiliation Information
University / Institution / Affiliation / Private Practice:
Department:
Position / Title:
Personal / Private Practice Website URL:
Education Information
Licensed?
Certified?
Professor?
Undergraduate School Attended:
Undergraduate Degree Completed on:
RadDatePicker
RadDatePicker
Open the calendar popup.
Graduate School Attended:
Graduate Degree Completed on:
RadDatePicker
RadDatePicker
Open the calendar popup.
Are you currently enrolled in a full time recognized Prosthodontic training program?
Other Information
Date of Birth
RadDatePicker
RadDatePicker
Open the calendar popup.
Other Organizational Memberships
Membership Reference List one (1) ICP Constituent Member for reference
First Name
Last Name
Email Address:

Supporting Documentation

After you click "Submit Application" and submit your initial payment, you will be prompted to upload any supporting documentation.
Supporting Documentation

Students:  Please upload a document supporting status of current enrollment, signed by Program Director.
Constituent Members:  Please upload supporting document of Prosthodontic Specialty License. If your country does not recognize the specialty of Prosthodontics, please provide the name of the local Prosthodontics organization of which you are a member.

Remember to press the Save Member button below

Select file to upload:  

 File NameUploaded
Zero documents uploaded, use button above to upload


Member Photos
Member Photos are optional.

(Note: Photo file extension cannot contain UPPER CASE characters (e.g. on your computer, right click & rename yourfile.JPG to yourfile.jpg)

Remember to press the Save Member button below

Select photo to upload:  

  Is Main PhotoPhoto NameUploaded
Zero photos uploaded, use button above to upload
Member Registration Payments
NOTE: IJP subscription will begin 4-6 weeks after payment. Mailing of back issues no longer provided. Refer to internet on-line subscription to view back issues.
                     



Pay 2 Years Dues at Once
(Optional. Check here to pay 2 years of dues & be current on membership dues for the next 2 years.
Your grand total will update below.)
Membership Amount Owed *
(Includes current membership year,
previous years (if any), any late fees or processing fees & any options selected above) 		$

Link to >> Download PDF Donation Form

Enter Donation amount:       $

Total amount of transaction: $

Credit Card Information
Card Number *
Card ID/CCV * (3 or 4 digit number on back of card)
Card Expires *
Name on Card * First: Last:
 
Please do not navigate away from this page or close your browser while payment is processing, this process can take up to one minute.


(Administrative Use Only!)
Username:
Password:
Payment History
Amount PaidDate
No records to display.
Donation History
Donation AmountTypeDate
No records to display.

Make a Donation
The ICP appreciates your generosity and support for the initiative listed below.
Donations to the ICP are directed to the Student Travel Grant Program, which
will provide partial travel funds for Students to attend the IADT Biennial Meetings.
Link to >> Download PDF Donation Form
Credit Card Information
Donation Amount $
Card Number
Card ID/CCV (3 or 4 digit number on back of card)
Card Expires
Name on Card First: Last:
 



(Administrative Use Only!)
Username:
Password:
Member Classification Change
  • If you are a Student and request change to Affiliate, press “Request Change” button for Affiliate
  • If you are a Student or Affiliate and request change to Constituent, 1st: fill out comment box below and provide information, then 2nd: press "Request Change" button to Constituent Member:
          Are you a full time senior teacher in prosthetic dentistry? Are you licensed or certified as a prosthodontist?
          Undergraduate school attended and degree? Graduate school attended, degree and date you received your degree?

  • If you are a Constituent member and request Life Member, fill out comment box regarding criteria posted under Life Member definition, then press "Request Change" button for Life Member.
The Membership Committee will review your request for consideration and respond shortly.

Comments:
 Classification
Affiliate (Annual Dues: $275, Processing Fee: $55 , Includes IJP: Yes)
Affiliates are Dentists or scientists* who do not qualify as Constituent members but have demonstrated contributions to prosthodontics. *Scientist is interpreted by the ICP as a clinical or basic scientist with graduate degree qualifications who has demonstrated a contribution to the specialty of prosthodontics.
Constituent (Annual Dues: $275, Processing Fee: $55 , Includes IJP: Yes)
Constituent Members of the College shall be those individuals who have completed an accredited formal prosthodontic training program or are licensed as a prosthodontist by their governing body/licensing authority for dentistry. In countries with no specialty course in prosthodontics, full-time senior teachers in prosthetic dentistry may qualify for constituent membership. Documents required to confirm certification as a prosthodontist or teacher.