The Academy of Clinical Dentistry
JAPANESE






Greetings from Hideaki Ueda

HISTORY

COMPREHENSIVE DENTAL TREATMENT

ORGANIZATION OF CLINICIANS

ACTIVITIES

PRIVACY POLICY



The Academy of Clinical Dentistry New Membership Registration

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New Membership Registration
*Name (Romanized) First name: Family name:
*Date of birth Year (four digits) Month Date
*Sex Male Female
*Contact preference Home Work
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*Contact method Email Fax
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*Payment method Credit card
* Payment by credit card must be made manually (not by automatic debit) every year. If you choose to pay by bank debit, you will be required to make the payment through the post office in your first year only, for which you will be sent a payment slip in the mail.
*Address for sending materials Home Work
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[Home]
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telephone number
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e-mail address
[Workplace]
*Workplace (name of company)
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Type of employment Business owner Employee Other
country
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address

telephone number
fax number
e-mail address
Academic history
Final academic qualification (name of university/college)
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Doctoral course
Year graduated from doctoral course
Field of expertise
*Field of expertise Dentistry Dental hygiene Dental Technician Other(e.g., research)
< Dentist >
Dentist Start of clinical practice Year (four digits) Month
Dentist registration No.
Field of expertise in dentistry
< Dental technician >
Dental technologist Start of clinical practice Year (four digits) Month
Dental technologist registration No.
Field of expertise in dental technology
< Dental hygienist >
Dental hygienist Year (four digits) Month
Dental hygienist registration No.
Field of expertise in dental hygiene
Other (e.g., research)
Other (e.g., research)
Academic society memberships
Other
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