SLAACD - Sri Lanka Academy of Aesthetic and Cosmetic Dentistry

Membership

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Please enter your personal information as the first step of the registration process. Still got questions about membership?, please read the membership information section.

Personal Information

First Name: *

Last Name: *

Birth Day: *

Gender: *
Male Female

Telephone: *

E-Mail: *

Provide the permanent address information. Depending on the country information you may be required to provide the postal/zip code.

Permanent Address

Address Line 1: *

Address Line 2:

Country: *

Province: *

City: *

Postal/Zip Code: *

Provide the official address information. Depending on the country information you may be required to provide the postal/zip code.

Official Address

Address Line 1: *

Address Line 2:

Country: *

Province: *

City: *

Postal Code: *

Please let us know your registration number for the Medical Council and other educational/professional qualifications.

Qualifications

SLMC Registration Number (If you are from Sri Lanka): *

Professional Qualifications (With university & year): *

To obtain a membership, you should provide names of 2 exsisting members as references. Please select any two members from the list and we will send them a notification, so they can accept your request through our website.

Membership Configuration

Reference (1): *

Reference (2): *

Membership Type: *

Payment Method: * (**)

Cheque/MO No.: *

Bank: *

** Please mail your payment in favour of "Sri Lanka Academy of Aesthetic & Cosmetic Dentistry (SLAACD)" to the Secretary, SLAACD Secretariat. 18/186A Dabare Mawatha. Colombo 5.

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