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NOTE: Please provide at least one mobile or home number.
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I am a member of the ADA in another state.
Which qualification are you currently studying?
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Which university are you currently attending?
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Which year do you intend to graduate?
I am on a Student Visa
Insurance Company
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I do not agree to the Association providing my contact details to its business partners so that they are able to provide me with offers that have been negotiated on behalf of members
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Has any insurance company in connection with Public Liability, Products Liability or Professional Indemnity insurance for you imposed special conditions, denied a claim or declined/cancelled a policy?
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Have you currently or in the past had a statutory complaint upheld against you or have you had membership of this organisation, or similar organisation, refused or terminated?
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To your knowledge, has there been or is there now any claim or circumstance which has given rise to or may give rise to a claim against you in relation to a dental practice?
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By submitting this online application to become a member of the Australian Dental Association (New South Wales Branch) Limited ACN 000 021 232 (Association) you agree as a member of the Association to be bound by its Constitution and By-Laws. You agree to uphold the professional and ethical obligations of membership at all times. You understand that membership also includes mandatory membership of the Australian Dental Association Inc. (Federal) and confirm that all information you have supplied is true and correct.

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