Canada Membership Application


Canadian Members: If you are a member of an ICOI Affiliated Society, please use our International New Membership Application and apply directly to the ICOI Central Office via fax 973.783.1175, email at icoi@dentalimplants.com, or mail to ICOI, 55 Lane Road, Suite 305, Fairfield, NJ 07004.

Once you have reviewed your information, you can send your information securely to ICOI where your membership will be processed within 1-2 weeks. Thank you for joining ICOI!

Thank you for joining ICOI! Your information is secure with us!

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Member Information

Prefix:
*First Name:
*Last Name:
Suffix:
Designation:
Practice/Business:
*Address 1:
Address 2:
*City:
*Province:  *Zip:
*Telephone:
*E-mail:
Fax:
Website:

Home Address

Address 1:
Address 2:
City:
Province:  Zip:

Experience in Implant Dentistry

Membership Specialization:
Implant Involvement:
Projected Graduation Date:

Account Information

You will need to create a web login & password to activate your membership.
Password must have at least six characters and one numeric value.

*Web Login:
*Password:
*Confirm Password:

Annual Canada Membership Includes:

  • Bi-monthly subscription to our peer reviewed journal, Implant Dentistry
  • International certification program: Fellowship, Mastership and Diplomate credentials
  • Quarterly subscription to ICOI World News, our international society newsletter
  • ICOI membership listing and link to your practice at www.icoi.org
  • Special member discounts to ICOI's solely sponsored meetings
  • Discounts on a wide range of textbooks and patient education materials
  • Two (2) certificates of membership - ICOI and IPS (Implant Prosthetic Section)

Annual Dues Membership

Please click on the Drop down Box below to choose your Member Type
As an added convenience, we accept Master Card, Visa and American Express payments.
*Name on Card:
*Card Type:
*Card Number:
*Expiration Date: