2012 Application for Membership

1619 Duke Street, Alexandria, VA 22314-3406, USA +1.703.548.0066 F +1.703.548.1883 E-mail: research@iadr.org www.iadr.org

Send Payment and Application to: IADR PO Box 75537 Baltimore, MD 21275-5537, USA Fax +1.703.548.1883

FIRST NAME DEPARTMENT INSTITUTION/COMPANY ADDRESS CITY BUSINESS TELEPHONE HOME TELEPHONE

LAST/FAMILY NAME TITLE

STATE/PROVINCE FAX E-MAIL

POSTAL CODE

COUNTRY

Optional: Gender: o male

o female

Date of Birth: __________________

STEP 1: REQUIRED IADR MEMBERSHIP

IADR Membership (Includes access to the online Journal of Dental Research)

Student

Dues

Member*

q $35.00

q $48.00 q $60.00 q $120.00

* See nal page to determine your World Bank classication.

STEP 2: REQUIRED DIVISION/SECTION MEMBERSHIP

You must pick a Division/Section based on your country of residence.

IADR Global Headquarters does not collect dues for the following Divisions/Sections, these dues are priced at $0. q Argentine Division q Panamanian Section q Kuwaiti Division q Indian Section q Brazilian Division q Paraguayan Section q South African Division q Iraqi Section Southeast Asian Division q Chinese Division q Russian Section Jordanian Section q q q East & Southern African Division q United Arab Emirates Section q Uruguayan Division q Mongolian Section q Israeli Division q Ecuadorian Section q Pakistani Section

DIVISION/SECTION MEMBERSHIP
You must pick a Division/Section based on your country of residence.

Student

Dues

Member

The following Divisions/Sections ask that you submit your dues to IADR. q American Association for Dental Research (AADR)

q Australian & New Zealand Division q British Division q Canadian Division q Chilean Division q Colombian Division q Continental European Division q Iranian Division q Irish Division q Japanese Division q Korean Division q Mexican Division q Nigerian Division q Peruvian Division q Scandinavian Division (Member category includes subscription to European Journal of Oral Sciences.) q Venezuelan Division q Costa Rican Section q Egyptian Section q Saudi Arabian Section q Sudanese Section q Syrian Section

q $30.00 q $10.00 q $10.00 q $10.00 q $0 q $0 q $19.00 q $10.00 q $0 q $10.00 q $5.00 q $10.00 q $10.00 q $10.00 q $15.00 q $10.00 q $5.00 q $10.00 q $0 q $0 q $0

q $120.00 q $60.00 q $45.00 q $60.00 q $20.00 q $22.00 q $38.00 q $20.00 q $15.00 q $50.00 q $35.00 q $25.00 q $20.00 q $10.00 q $70.00 q $10.00 q $5.00 q $10.00 q $20.00 q $10.00 q $20.00

STEP 3: JOURNAL OF DENTAL RESEARCH

Student
Print edition of the Journal of Dental Research

Rates
Member

q $25.00

q $50.00

STEP 4: IADR SCIENTIFIC GROUP/NETWORK MEMBERSHIPPlease check those which you wish to join and include
accompanying dues as noted. Student members may join up to 3 Scientic Groups/Networks with no additional dues required.
q Geriatric Oral Research ($65) q Implantology Research ($15) q International RDC/TMD Consortium Network ($25) q Microbiology/Immunology ($20) q Mineralized Tissue ($20) q Network for Practice-based Research ($25) q Neuroscience ($16) q Nutrition Research ($15) q q q q q q q q q q Behavioral, Epidemiologic & Health Services Research* ($5, $10, $30) q Cariology Research* ($4, $4, $15) q Craniofacial Biology ($22) q Dental Anesthesiology Research ($20) q Dental Materials ($16) q Diagnostic Sciences* ($4, $8, $17) q Education Research* ($5, $5, $25) q Evidence-based Dentistry Network* ($11, $15, $20) Oral & Maxillofacial Surgery ($10) Oral Health Research ($15) Oral Medicine & Pathology ($25) Periodontal Research ($14) Pharmacology/Therapeutics/Toxicology ($20) Prosthodontics ($18) Pulp Biology & Regeneration ($20) Salivary Research ($19) Women in Science Network ($25)

*Scientic Group/Network Dues are based on World Bank Classication.

BRITISH DIVISION SCIENTIFIC GROUP MEMBERSHIP

q Behavioral Sciences ($0) q Oral Medicine & Pathology ($0) q Dental Materials ($0) q Implant Research ($0) q Oral Microbiology & Immunology ($0) q Periodontal Research ($0) q Mineralized Tissue ($0)

STEP 5: AADR SECTION MEMBERSHIP

AADR San Francisco Section (U.S. Zip Codes 93600-96999) AADR Southern California Section (U.S. Zip Codes 9000-93599)

Student
q $14.00 q $14.00

Dues

Member
q $14.00 q $14.00

STEP 6: TOTAL SELECTED ITEMS

DUES & FEES

IADR membership is based on a calendar year (January 1-December 31). During the months of July and August, you may pay half the IADR membership annual dues. If you join from September through December, your membership and related items will be activated the following January. IADR Dues (includes Journal of Dental Research online-only). Division/Section Dues Optional Print Journal Subscription IADR Scientic Group/Network and British Division Scientic Group Dues (Students may join up to 3 at no cost.) AADR Section Dues TOTAL REQUIRED $ REQUIRED $ $ $ $ $

STEP 7: PAYMENT OPTIONS

Check Total Enclosed: $_____________ Make check payable to IADR in U.S. dollars. Check must be drawn on U.S. bank.
q Credit Card
CARD NUMBER PRINT NAME OF CARDHOLDER BILLING ADDRESS

Amount of Charge: $_____________ q Visa

q MasterCard

q American Express

Source Code: WEB

EXP. DATE

CARD ID NO. (the small number printed on the front or back of your credit card) SIGNATURE

ELIGIBILITY FOR STUDENT MEMBERSHIP REQUIRED

I understand that my eligibility for special student membership fees is based on my full-time enrollment in the educational course indicated below. Student Membership is limited to 8 years, or completion of studies, whichever comes rst, at which time Member category dues will be assessed. Enrollment Attested
SIGNATURE OF DEAN OR FACULTY ADVISOR NAME AND TITLE (PLEASE PRINT OR TYPE)

EDUCATIONAL INSTITUTION

The expected completion date of my educational course or program is: (month/year) __________ /__________ q Masters Student with no professional degree q Masters Student after professional degree q PhD Student with no professional degree q q q q PhD Student after professional degree Dual Degree Program Student Post-doctoral (Dental or Medical Fellow and PhD) Other

Student Type - Please select your current student type below. q College, University, pre-Dental or Secondary Student q DDS/DMD or BDS Student q MD or DO Student

COUNTRY
Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Dem. Rep. Congo, Rep. Costa Rica Cte dIvoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt, Arab Rep. El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Polynesia Gabon Gambia, The Georgia Germany Ghana Gibraltar

WORLD BANK 2012 IADR COUNTRY CLASSIFICATION MEMBER DUES

Low income Upper middle income Lower middle income Upper middle income High income Lower middle income Upper middle income Upper middle income Lower middle income High income High income High income Upper middle income High income High income Low income Lower middle income Upper middle income High income Lower middle income Low income High income Low income Lower middle income Upper middle income Upper middle income Upper middle income High income Upper middle income Low income Low income Low income Lower middle income High income Lower middle income High income Low income Low income Upper middle income Upper middle income Upper middle income Low income Low income Lower middle income Upper middle income Low income High middle income Upper middle income High income Lower middle income High income Lower middle income Upper middle income Upper middle income Upper middle income Lower middle income Lower middle income High income Low income Lower middle income Low income High income Lower middle income High income High income High income Upper middle income Low income Lower middle income High income Low income High income $ 48.00 $ 60.00 $ 48.00 $ 60.00 $120.00 $ 48.00 $ 60.00 $ 60.00 $ 48.00 $120.00 $120.00 $120.00 $ 60.00 $120.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $120.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $ 60.00 $ 60.00 $120.00 $ 60.00 $ 48.00 $ 48.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $ 60.00 $ 60.00 $ 48.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $ 60.00 $120.00 $ 48.00 $120.00 $ 48.00 $ 60.00 $ 60.00 $ 60.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $120.00 $120.00 $120.00 $ 60.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $120.00

COUNTRY
Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Rep. Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Dem. Rep. Korea, Rep. Kosovo Kuwait Kyrgyz Republic Lao PDR Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, FYR Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia, Fed. Sts. Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Northern Mariana Islands

WORLD BANK 2012 IADR COUNTRY CLASSIFICATION MEMBER DUES

High income High income Upper middle High income Lower middle Low income Low income Lower middle Low income Lower middle High income High income High income Lower middle Lower middle Upper middle Lower middle High income High income High income High income Upper middle High income Upper middle Upper middle Low income Lower middle Low income High income Lower middle High income Low income Low income Upper middle Upper middle Lower middle Low income Upper middle High income Upper middle High income High income Upper middle Low income Low income Upper middle Upper middle Low income High income Lower middle Low income Upper middle Upper middle Upper middle Lower middle Lower middle High income Lower middle Upper middle Lower middle Low income Low income Upper middle Low income High income High income High income High income Lower middle Low income Low income High income $120.00 $120.00 $ 60.00 $120.00 $ 48.00 $ 48.00 $ 48.00 $ 48.00 $ 48.00 $ 48.00 $120.00 $120.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $120.00 $120.00 $120.00 $ 60.00 $120.00 $ 60.00 $ 60.00 $ 48.00 $ 48.00 $ 48.00 $120.00 $ 60.00 $120.00 $ 48.00 $ 48.00 $60.00 $ 60.00 $ 48.00 $ 48.00 $ 60.00 $120.00 $ 60.00 $120.00 $120.00 $ 60.00 $ 48.00 $ 48.00 $ 60.00 $ 60.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $ 60.00 $ 60.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $ 60.00 $ 48.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $120.00 $120.00 $120.00 $ 48.00 $ 48.00 $ 48.00 $120.00

COUNTRY
Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Samoa San Marino So Tom and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka St. Kitts and Nevis St. Lucia St. Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, RB Vietnam Virgin Islands (U.S.) Yemen, Rep. Zambia Zimbabwe

WORLD BANK 2012 IADR COUNTRY CLASSIFICATION MEMBER DUES

High income High income Low income Upper middle Lower middle Upper middle Low income Lower middle Upper middle Lower middle High income High income High income High income Upper middle Upper middle Low income Lower middle High income Low income High income Lower middle Upper middle Upper middle Low income High income High income High income Low income Low income Upper middle Low Income High income Lower middle Upper middle Upper middle Upper middle Lower middle Upper middle Lower middle High income High income Lower middle Upper middle Low income Low income Upper middle Low income Low income Lower middle Lower middle Upper middle Upper middle Lower middle High income Lower middle Low income Lower middle High income High income High income Upper middle Lower middle Lower middle Upper middle Lower middle High income Lower middle Low income Low income $120.00 $120.00 $ 48.00 $ 60.00 $ 40.00 $ 60.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $120.00 $120.00 $120.00 $ 60.00 $ 60.00 $ 48.00 $ 48.00 $120.00 $ 48.00 $120.00 $ 48.00 $ 60.00 $ 60.00 $ 48.00 $120.00 $120.00 $120.00 $ 48.00 $ 48.00 $ 60.00 $48.00 $120.00 $ 48.00 $ 60.00 $ 60.00 $ 60.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $120.00 $ 48.00 $ 60.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $ 48.00 $ 48.00 $ 48.00 $ 60.00 $ 60.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 48.00 $120.00 $120.00 $120.00 $ 60.00 $ 48.00 $ 48.00 $ 60.00 $ 48.00 $120.00 $ 48.00 $ 48.00 $ 48.00

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