IDIT Registration Form

Get guaranteed hands-on results at UOD with two-per-chair mentoring.

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This field is for validation purposes and should be left unchanged.

Submission ID

Personal Information

Name(Required)

First Last

as on passport

Preferred Name

Optional, for badge

Phone(Required)

Mobile, WhatsApp. Include country code (e.g., +1, +44)

Email(Required)

Enter Email Confirm Email

City State / Province / Region Country

Professional Details

Primary Speciality(Required)

Practice / Clinic Name

Years in Practice(Required)

Please enter a number from 1 to 99.

Country of Licensure(Required)

License Number(Required)

Issuing Authority / State(Required)

License Expiration Date

Month

Day

Year

AGD Member Number

Select Your Level

Training Level(Required)

Level 1

Level 2

Have you completed a basic implantology theory course?*(Required)

A basic implantology theory course is required to access both levels. If you don’t have one yet, complete HKU’s “Implant Dentistry” (Coursera)

Provider/Institution of your theory course

Upload basic implantology theory certificate(Required)

Accepted file types: jpg, png, pdf, jpeg, doc, docx, Max. file size: 10 MB.

How many implants have you placed?(Required)

Please enter a number greater than or equal to 1.

Have you performed sinus lifts before?(Required)

Are you comfortable with GBR and flap management?(Required)

Upload experience proof (log/statement)(Required)

Accepted file types: jpg, png, pdf, jpeg, doc, docx, Max. file size: 10 MB.

Briefly describe your advanced surgical experience(Required)

Goals & Preferences

What are your learning goals for the week?

Scrub Size(Required)

Dietary Needs

Allergies

Accessibility Needs

Preferred Language for support

Dates & Travel

Preferred Course Date(Required)

Alternative Date

Will you use our airport transfer service? (Service from Las Américas Airport only)(Required)

Arrival Date

Month

Day

Year

You can provide later

Arrival Time

Hours

Minutes

AM/PM

You can provide later

Document Uploads

Passport (photo page)(Required)

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 10 MB.

Dental License(Required)

Accepted file types: jpg, png, pdf, jpeg, doc, docx, Max. file size: 10 MB.

Dental Degree / Diploma(Required)

Accepted file types: jpg, png, pdf, jpeg, doc, docx, Max. file size: 10 MB.

Headshot Photo(Required)

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 10 MB.

Admittance(Required)

I confirm I am a licensed dentist

Consent(Required)

By checking this checkbox I admit I've read an accepted the following pages: Terms of Service* and Privacy Policy*