National Society Membership Form

Online National Society Membership Application Form

Your Name & Surname

Your Email Address

Your Contact Number (please include country code)

Name of Association

Association Address

Association's Email Address

Association's Website Link (if applicable)

Association Contact Number (please include country code)

Number of Members in Association

Name of Association's President

Email of President

Terms of Office (number of years)

President's term started on / will start on (date):

Name of Association President Elect

Email of President Elect

Name of Association Secretary General

Email of Secretary General

Terms of Office (number of years)

Secretary General's term started on (date)

The editors of the International Journal of Paediatric Dentistry would like to publish profiles of the National Societies of IAPD to inform the readership of the challenges facing paediatric dentists worldwide. To do this could you please provide a short report which addresses the following questions, (200/300 words). Please include a photograph (if possible) representing some characteristics of your country.

Estimated Number of Paediatric Dentists (nationwide)

Does your government recognize peadiatric dental specialists (yes/no)?

How are dental services for children organised?

Are the above-mentioned services private practice/ state funded/ community-based?

Population statistics: Please indicate the total population:

Population statistics: Please indicate the total polpulation under 16 years of age:

Please indicate the mean dmft value for 5 & 12 year old children:

Is drinking water fluoridated (yes / no)?

Please indicate the number of undergraduate dental schools:

Any additional information you think would be relevant?

Please upload your Society's Constitution

Please upload your Society's List of Officers:

Please upload your logo (if applicable)

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National Society Membership Form

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