AID REGISTRATION

First Name

Dr.

Required ^*

Last Name Required ^*

Age Required ^*

Sex

Year Of Graduation Required ^*

Name of Dental College Required ^*

Year Of Post Graduation

DCI Registration No. Required ^*

Practice Name Required ^*

Practice Address Required ^*

City Required ^*

Pincode Required ^*

State/UT Required ^*

Mobile

+91

Email ID Required ^*

Area of Specialization

Upload your DCI registration certificate

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Upload your profile pic

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Are you practicing Implant Dentistry

Years of Implant practice Required ^*

How many Implants do you use per year?

Can you provide on-site support to the new Implant practitioners in your city?

NAME THE IMPLANT SYSTEMS YOU HAVE BEEN USING

Would you like to join AID Team as a Mentor/Speaker?

WOULD YOU LIKE TO PROVIDE E CONTENTS Required ^*

WHAT WOULD BE YOUR REMUNERATION FOR PROVIDING ON-SITE surgical support

WHAT WOULD BE YOUR FEE FOR PROVIDING ONLINE GUIDANCE TO THE NEW IMPLANT PRACTITIONERS ? (FEE PER CASE BASIS)

WOULD YOU PREFER TO DO A LIVE SURGERY ON YOUR OWN PATIENT

WOULD YOU LIKE TO JOIN US FOR A FREE OF COST BASIC IMPLANT SURGICAL TRAINING PROGRAM

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