Register for Membership

Username

First Name

Last Name

Password

Password Again

Health Agency

Street Address

Street Address 2

City

Province

Postal Code

Work Phone

Cell Phone

Who is paying for your OAPHD membership? Health Unit Self

What is your position held at Agency?

Professional Designation

Is your primary employment in Dental or Oral Health? Yes No

Other dental or or public health associations you belong to:

Please note: If you need to pay for your membership by cheque, please contact secretary@oaphd.on.ca and include the details from the form above.