Membership Renewal

Membership Renewal
Annual membership fee:

$100.00 Active Member
$ 50.00 Associate Member
(Certified Pediatric Dentist,
No Specialty License)
$ 50.00 Affiliate Members
No Fee Graduate Student Resident

Make check payable to ISPD

Thank you for taking the time to complete this renewal application.

Please return completed renewal application and membership fee to:

Ms. May Stern
Illinois Society of Pediatric Dentists
University of Illinois at Chicago
Department of Pediatric Dentistry (M/C 850)
College of Dentistry
801 S. Paulina Street
Chicago, IL 60612-7211
E-mail: maysie@uic.edu

 



Last Name  First Name  M.I. 

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Office Address #2 
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Please check here if you prefer your information not to be posted on the website.

Illinois Society of Pediatric Dentists
M/C 850
801 South Paulina Street
Chicago, IL 60612
312/413-7714