Online Membership Application

Australian Dental Prosthetists' Association (Victoria)
9 Church St
Hawthorn
VIC. 3122

 Tel: (03)  9852-9969
Fax: (03) 9852-9469
Email: admin@adpavic.com.au
Applicant Name: *
Surname: *
Qualification: *
 Home Address: *
Suburb: *
Post Code: *
Private Phone: *
Email:
Self employed? Yes   No             *
Main Practice Address: *
Suburb: *
Post Code: *
Business Phone: *
Fax: *
Position Held: *
Website Address:

STATUS UNDER DENTAL TECHNICIANS’ ACT 1972 & REGISTRATION / LICENCE NUMBER :

(DENTAL PRACTICE BOARD OF VICTORIA - REGISTRATION NUMBER)
* 
 search here to find your licence number.

Membership fees (1st January to 31st December, annually) for a licenced Dental Prosthetist is
$450:00, plus GST ($45.00) = $495.00 P.A.
For an Undergraduate the fee is $225.00, plus GST ($22.50) = $247.50 P.A.
Dental Prosthetist or Undergraduate ANNUAL FEE: (please pay for full year)

                       

 

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