RAOI Membership Form

Please complete all relevant sections, read the declaration and sign the form. Incomplete or unsigned forms cannot be processed and will be returned. Click on the grey area to enter the information.

(Please choose the correct option)

Membership Category:

New

Renewal

Referral Name of affiliate society / colleague if any:

Membership Number (in case of renewal)

Members are entitled to a RAOI 3-yr REDUCED Membership fee of US$/€/£ 450 (recommended if you are applying for a credential).

SECTION 1 – Applicants Personal Details

Title: Dr.

Date of Birth (dd/mm/yyyy):

First Name:(Required)

Last Name:

Gender(Required)

Male

Female

SECTION 2 – Contact Details

CLINIC Address:

Postcode/Zip code:

Country:

Email:(Required)

Mobile:

Work Phone (include country and area code):

SECTION 3 – Qualifications

Primary qualification:

Name of awarding Institution/College:

Higher qualifications (please list)

Country of licensure:

License Number:

UK / US – Board Certified or equivalent:

Yes

SECTION 4 – Payment Information

I am paying for (choose the relevant options):

RAOI 3yr Membership Fee (US$/€/£ 450)

RAOI Annual Membership Fee (1yr) (US$/€/£ 300)

3yr Credential Revalidation Fee (US$/€/£ 200)

Note: You can revalidate your credential(s) at the time of renewal.

I want to revalidate the following certificate(s) (please select relevant options):

Fellowship

Mastership

Diplomate

Board Certified

2. Direct Bank transfer to the account detailed below:

Account Name: The Royal Association

Bank Name: Bank of Texas

Account Number: 8096580541

Bank Address: PO Box 29775, Dallas, TX 75229-0775, USA

Bank Swift Code: BAOKUS44

Bank Number: 14

A confirmation of the same must be sent by email to:info@raoi.org

SECTION 4 – Declaration

I, (full name of applicant), hereby declare that all the information submitted in this application is accurate and true. 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 (dd/mm/yyyy):

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 (dd/mm/yyyy):

Please complete all relevant sections, read the declaration and sign the form. Incomplete or unsigned forms cannot be processed and will be returned. Click on the grey area to enter the information.

SECTION 1 – Applicants Personal Details

SECTION 2 – Contact Details

SECTION 3 – Qualifications

SECTION 4 – Payment Information

2. Direct Bank transfer to the account detailed below:

SECTION 4 – Declaration

Data Privacy

If You want to make Payment Offline - Download Form Here

Application Forms

RAOI Board Certified Application form

RAOI Diplomate
Form

RAOI Fellowship Form

RAOI Mastership Form