Non-Members - Apply Online

Doctors interested in biological dentistry and its impact on general health derive great benefit, and feel right at home as members of the IAOMT. Membership is open to dentists, medical doctors, and research professionals. Doctors with other degrees such as chiropractors and naturopaths are welcome, with certain additional conditions.

Please contact our office for more details.

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MEMBERSHIP TYPE

All memberships are renewed annually on July 1st. The price of membership is subject to being prorated. The amount you owe today will be listed on the next page where you make your payment.

Dental or Medical Student ($15/yr) Standard Membership ($395/yr. Plus $100 application fee.) Senior ($200/yr. Over 65, and not practicing but want to stay involved.)

CHAPTER

Are you a member of an International Chapter?

Yes No

NAME

First Name * Middle Initial Last Name *

LOGIN

Username * no spaces Password *no spaces

PHONE & EMAILS FOR IAOMT COMMUNICATION

We will not share your primary and secondary email addresses with the general public. This information will be available only to other IAOMT members and for IAOMT Admin purposes such as renewal notices, conference announcements, news updates, etc.

Primary Phone * Secondary Phone Other Phone Fax Primary Email * Secondary Email

ADDITIONAL INFORMATION

Educational Degreecheck all that apply

Other Year of Graduation Spouse Name Website How did you hear about IAOMT?

PRACTICE MAILING ADDRESS

Practie Profile information will be displayed in the public patient directory.

Address 1 * Address 2 apt/suite City * State *Inside US / Canada

Outside US / Canada

Zip/Postal Code *

PRACTICE DETAILS (for public directory)

We recommend that you include your areas of expertise (i.e. Orthodontics, Endodontics, Safe Amalgam Removal, Detox Medicine, Oxygen Ozone Therapy) in the Practice Description field.

Include me in Public Membership Listing

Practice Name Practice Phone Practice Email Practice Website URL Practice Description

Please include your areas of expertise. 250 words max.