RAOI Board Certified Application form All parts of this application form must be completed and duly signed by the applicant. The completed form together with the applicant’s current CV, a photograph, proof of CE hours and Case Documentation CD should be sent to the address mentioned at the end of the form OR can be uploaded through the upload portal on the website www.RAOI.org Applicants who are not Members of RAOI or have not renewed their Membership, are required to apply for Membership along with their Board Certified application. RAOI Diplomate is a pre-requisite for Board Certified applications Payment for the Board Certified credential must be made in advance to the account mentioned on the form. A confirmation of the same must be sent by email to: info@raoi.org Successful applicants will be given a Board Certified certificate with a validity of 3 years. After 3 years, the Board Certified certificate must be revalidated (Revalidation Fee: $200). This can be done along with renewal of Membership and submission of evidence of 50 CE hours annually in the preceding 3 years. A revalidated certificate will have a validity of 3 years(Please choose the correct option)Are you a Member of RAOI? (Membership is necessary) YES NO RAOI Membership Number:I want to apply for RAOI 3-yr Membership (for new Members only) I want to apply for RAOI 3-yr Membership (for new Members only) SECTION 1 – Applicants Personal DetailsTitle: Dr. Date of Birth (dd/mm/yyyy): First Name:(Required) First Last Name: Gender(Required) Male Female SECTION 2 – Contact DetailsCLINIC Address: Postcode/Zip code: Country: Email:(Required) Mobile:SECTION 3 – Payment InformationI am paying for (choose the correct option): RAOI 3yr Membership AND RAOI Board Certified (US$/€/£2450) – choose if you are not an ACTIVE RAOI Member RAOI Board Certified (US$/€/£2000) - choose if you are an ACTIVE RAOI Member and only applying for Board Certified RAOI Board Certified Examination (US$/€/£1000) (mandatory for Board Certified applicants) RAOI Board Certified will only be awarded at the RAOI Annual conference or a co-sponsored symposium I would like to receive my Board Certified Certificate at the following RAOI symposium: (please note, a separate registration form and fee will have to be submitted at the relevant symposium where you are receiving your award)2. Direct Bank transfer to the account detailed below:Account Name: The Royal AssociationBank Name: Bank of TexasAccount Number: 8096580541Bank Address: PO Box 29775, Dallas, TX 75229-0775, USABank Swift Code: BAOKUS44Bank Number: 14A confirmation of the same must be sent by email to: info@raoi.orgSECTION 4 – DeclarationI, (name of applicant), hereby declare that all the information submitted in this application is accurate and true and the cases submitted have been done by me. I also confirm I have completed the requisite CE hours and submitted copies of the certificates for the same. I understand if any of the information submitted by me is proved otherwise, my application will be rejected, and the payment made by me towards my application will be forfeited.Signed: Name: Date: Data Privacy We are committed to ensuring that your privacy is protected. The information you provide here will only be used for the purposes of processing and approving your membership / credential request and obtaining membership / credentialing benefits. In accordance with data protection regulations we require your consent for this. The data for successful applicants will be held on our membership system. I understand that RAOI will store and use the data I submit here for the purposes of processing my membership / credential request and obtaining membership / credentialing benefits. The RAOI is occasionally asked by employers, government bodies or other similar organisations to verify an individual’s membership/credential status for employment purposes. I consent to The Royal Association of Oral Implantologists providing verification of my membership and credential status to third parties.Signed: Name: Date: Board Certified requirements 1. RAOI Diplomate is a pre-requisite for Board Certified applicants 2. Case requirements for submission: 500 documented cases with at least 5-year follow-up. Details of documentation for the cases are listed on the Board-Certified form. At least 50 cases should have a difficulty level of advanced to complex. All cases must be adequately documented and submitted digitally as a PowerPoint. They can be uploaded through the upload portal on the website. 3. CE hours: Candidates to submit proof of completion of at least 500 CE hours in the preceding 3 years (attained either through online courses or seminars or teaching courses) 4. Publications in Peer-Reviewed Journals: Candidate should have published at least 3 research papers on the subject in peer-reviewed journals. 5. Candidate will present his cases and peer-reviewed research during the Annual RAOI Congress during a special session. 6. Compulsory written exam and Viva assessment 7. Photograph and a current Curriculum Vitae 8. RAOI 3-Year Membership Fee: US$/€/£ 450 9. RAOI Board Certified Application Fee: US$/€/£ 2,000 10. RAOI Board Certified Examination Fee: US$/€/£ 1,000The Board Examination will be held in the presence of at least 2 Board Members The Examination Fee will be paid directly to Board Members • All fees are strictly non-refundableRAOI Board Certified Maintenance Requirements: 1. RAOI Board Certified must be active Members to retain their Board- Certified status. The Board-Certified certificate issued will bear a validity of 3 years. After 3 years, Board Certified members must ensure they renew their RAOI Membership and revalidate their Board Certified status(a certificate with a new validity date will be issued upon paying the renewal and revalidation fee). Non-renewal will result in delisting from the Members and Board-Certified directory. If the renewal is not done within a year from the date of expiry, past dues will have to be paid should the applicant decide to renew in future. Fees payable at this time to receive a new Board Certified certificate is: RAOI 3-Year Membership Fee: US$/€/£ 450 RAOI Board Certificate Revalidation Fee: US$/€/£ 200 2. Submit evidence of a minimum of 50 CE hours annually at the time of renewal for revalidation of Board-Certified certificate. 3. Attendance to at least one RAOI Annual Conference or the National Annual Symposium of the candidate’s specialty in 3 yearsCASE DOCUMENTATION FORMAT: Given below is a guideline for the required documentation of cases submitted for Board Certified application. Cases should be documented digitally in a slide format. All clinical pictures and radiographs should be appropriately labelled. The presentation of each case should include the following details in the order given: Case number (e.g. Case1) Patient Initials / Code name (e.g. RT) Patient medical history Dental history and current dental status Pre-operative radiograph and clinical picture Recommended treatment plan Date of surgery Details of Pre-Implant grafting, if carried out. Add relevant clinical picture Number of implants placed and their location Augmentation procedure carried out with clinical picture Post-operative radiograph and clinical picture Postoperative maintenance Type of implant restoration Date of prosthesis delivery Post prosthesis radiograph and clinical picture Clinical picture and radiograph of 2-year functional prosthesis Pointers for submitting your cases All cases should be documented in a single presentation and saved as a single file. One case equates to one patient. The same can be uploaded through the upload portal on the site. Remember to label the first slide of every case with the case number and patients initials (e.g. Case1 – RT). Complete the case documentation template in its entirety for each case. If you do not have the information, provide rationale or if it does not apply, write N.A. Required radiographs: - Pre-Op - Post-Surgical - Post Prosthetic - Image with the final restoration(s) in function for a minimum of 2 years CT scans are admissible but not mandatory, however only include the relevant slices Required photos: (both pre-op and post-op) - Occlusal view of maxillary and mandibular arch - Frontal view, left side and right side in maximum intercuspation position (MIP) - Occlusal views of all implant attachment mechanisms - Views of tissue surface areas of the removable prostheses The candidate must ensure due diligence to submit cases that are complete and accurate. The declaration on the last page of the application form must be duly signed. In the event the candidate is found not to have made an honest and accurate submission, the application will be rejected without any refund of fees.Please send your completed forms, documents and cases to: Ms. Dolna Saldanha RAOI Executive Secretary 806 Thomson Road #16-12 Thomson 800 Singapore 298189 Mobile: +65 8571 6046 Email: dolna@RAOI.orgIf You want to make Payment Offline - Download Form Here Application Forms RAOI Diplomate Form RAOI Fellowship Form RAOI Mastership Form RAOI Membership Form
