Academic Meeting Participation Fees*(check the box that applies to you)
Type of registration Members must register as “members.” Changes cannot be made after registration.
Member dentist \27,000
Non-Member dentist \31,000
Member dental technician \12,000
Non-member dental technician \15,000
Member dental hygienist \12,000
Non-member dental hygienist \15,000
Dental assistant \12,000
Name* First name Family name
The information entered will be printed directly onto your name card.
Please be sure to enter information accurately.

Membership number*
Be sure to enter your membership number if you have one.Your membership number is printed on the back of your member’s card.
Age
Sex Male Female
Membership history Years
E-mail* (e.g., example@ago.ac)
Please make sure you have entered your e-mail address accurately.
Name of your office/workplace
Address for sending materials Work Home