IUSD Student Membership Activation Form

To activate your IUSD Student Membership, please complete the form below. IDA is incredibly sensitive to privacy! We do not sell or share personal member information.

First Name *

Last Name *

Phone Number *

Your preferred email (required) *

Your hometown and state/country *

In which IUSD program are you enrolled? Limit 500 Characters

When you are not attending dental school, what would we find you doing? Limit 500 Characters

Yes, I would like to activate my membership in the Indiana Dental Association and receive occasional emails from the IDA (You can unsubscribe anytime)

Constant Contact Use. Please leave this field blank.

By submitting this form, you are consenting to receive marketing emails from: Indiana Dental Association, 550 W North Street | Suite 300, Indianapolis, IN, 46202, http://www.indental.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

IUSD Student Membership Activation Form

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