Application for Membership

General Information

Personal Information

Marital Status
Blood Group
Spouse Dentist
Spouse A Member OF IDA

Educational Qualification

UG Qualification*

PG Qualification

Home Address


Contact Information

Practice Information *

Subscription *

Membership Fees (includes subscription fees, activity fees and service tax)

BANK DEPOSIT / ONLINE BANKING to ICICI BANK A/C No: 602801119067 AlcName: "IDAMADRAS BRANCH" IFSC Code: ICIC0006028 Branch: Alwarpet, Chennai.

Declaraion *

I declare that I have read the details of the IDA Constitution. Bye- Laws. Code of Ethics & Professional conduct and resolve to abide by them. I am not a member of any association functioning parallel to IDA (This does not include specialty societies.) in any area & have not been convicted by any court of low. I am not engaged in any activity detrimental to the interest of any association. I solemnly declare that the contents of this application form are correct to the best of my knowledge and information. I agree that if anything contained here is found to be false, my membership if Indian Dental Association is liable to be cancelled immediately.