Member Application Form
    Fill out each tab below, clicking [Submit Information] when completed, then click [Submit Application].

Member Overview / Summary
Contact Info Email Address needs to be updated:
Contact Info Mailing Address needs to be updated:
Contact Name:
Membership ID:
Contact Email Address:
Affiliation:
Membership Classification(s):
APS Federal Classification:
Current Amount Due: $0        
Make a Donation:
Contact information made available on APS website:
APS Membership Federal Fees – select one of the following fees if you are applying for APS membership.
  • Full (Ordinary) (Annual Dues: $70)
    Ordinary members of the Society are those individuals who are registered Dentists or Dental Specialists who are resident in Australia and who maintain an active interest in the study of prosthodontics.
  • Associate Post-Graduate Student (Annual Dues: $35)
    Post-Graduate Student Members of the Society shall be those individuals who are enrolled in an accredited full-time prosthodontic training program within Australia. Letter from Director of Program or other evidence of enrollment is required.
      Mail to: Dr Alister Dickson - APS Federal Secretary
      Victoria Park Specialist Centre, 164 Fullarton Rd Road, Dulwich SA 5065
  • New Graduate (Annual Dues: $35)
    New Graduate members are those dentists who have graduated from dental school and been registered 1 year or less.
  • Country (Annual Dues: $70)
    Country members of the Society are those individuals who are registered Dentists or Dental Specialists who reside and practice in a non-metropolitan or provincial district and who maintain an active interest in the study of prosthodontics.
  • Corresponding (Annual Dues: $35)
    Corresponding Members of the Society are those individuals who are registered Dentists or Dental Specialists who are not resident in Australia and who maintain an active interest in the study of prosthodontics.
Member / Contact Information
Federal Fee:               

APS Annual Dues. Select your appropriate State and related fees. Required to select one of the choices from Drop Down Menus below:

APS Branch Fees:     
NSW
QLD
SA
VIC
WA
 
First Name/Given Name/Forename:
Last/Surname/Family Name:
Country:
Address 1:
Address 2:
City:
State/Province/Region:
Zip/Postal Code:
Telephone Number (include country code):
Email Address:

Check box to include your information on public APS website pages: Specialist member (for Specialist) and Find a member (for all members).    Information will include name, business address, phone number
Check box to include your email address on any public APS web page.   
Login Information
How did you hear about the APS?
Username:
Password:
Confirm Password:
JPD Information
The JPD is optional. The JPD is accessible online through the Members Only links below. A hard copy will also be mailed.

The JPD fee is $220 .Complete the Mailing Address fields below for hard copy JPD delivery. Subscription is for 1 calendar year.
Pay for the journal on the "Payment" tab
.

Mailing Address
Same as Contact Information?
Country:
Address 1:
Address 2:
City:
State/Province/Region:
Zip/Postal Code:
Journal Request History
to change your mailing address on an existing order below, click 'Edit Address' which will load the address above. Then click 'Save Updated JPD Address'
Education Information
Title(s):
Other:
Specialist Registration:
Undergraduate School Attended:
Undergraduate Degree Completed:
Graduate School Attended:
Graduate Degree Completed:
Affiliation Information (type N/A for any fields that are not applicable)
University / Institution / Affiliation / Private Practice:
Department:
Position / Title:
Personal / Private Practice Website URL:
AHPRA Registration Number:
ADA Membership Number:
Other Information
Date of Birth: / /
Other Organizational Memberships:
Publications: Publications: List authors, article title, publication name and published date.
Example: Fitzpatrick BJ, Brockhurst P, Gullotta E. Determination of gold alloy loss during the production of cast dental restorations. Australian Dent Journal; Accepted for publication January 1998
Member Photos

(Note 1): Photo file extension cannot contain UPPER CASE characters (e.g. on your computer, richt click & rename yourfile.JPG to yourfile.jpg
(Note 2): Photo upload works best if your photo name does not contain any spaces or "special keyboard characters", please try to name with only English alphabet or numbers.


Select photo to upload:  

  Is Main PhotoPhoto NameUploaded
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Member Registration Payments

                     


Credit Card Information
Total Amount Owed
(includes any late fees and/or processing fees)
$0
Breakdown of Fees
Card Type
Card Number
Card ID/CCV (3 or 4 digit number on back of card)
Card Expires
Name on Card * First: Last:
 
Please do not navigate away from this page or close your browser while payment is processing, this process can take up to one minute.


(Administrative Use Only!)
Username:
Password:
Payment History
Amount PaidDate
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Donation History
Donation AmountDate
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Make a Donation
Credit Card Information
Donation Amount $
Card Type
Card Number
Card ID/CCV (3 or 4 digit number on back of card)
Card Expires
Name on Card * First: Last:
 
please allow time to process, process can take up to a minute



(Administrative Use Only!)
Username:
Password:
Member Classification Change
  • If you are a Student and request change to Associate Student, submit “Request Change” for Associate Student
  • If you are a Student or Associate Student and request change to Ordinary, submit “Request Change” for Ordinary
  • If you are an Ordinary member and request “Corresponding”, fill out comment box regarding criteria posted under Corresponding definition.
  • If you are an Ordinary member and request “Retired”, fill out comment box regarding criteria posted under Retired definition.
The Membership Committee will review your request for consideration.

Comments:
 Classification
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Member Resources...
Members must be current with annual dues to link to ICONS.

Any "pop-up blocker" also has to be turned off To load these Members Only links.
APS - Australian Prosthodontic Society Inc.        Upwey Dental Shop 3, 9-21 Main Street Upwey VIC 3158 Australia        E: apsincsec@gmail.com