IADMFR Membership Renewal Form 

Last Name:
First Name:
Member ID #:
Email:

Please make payable to:
"International Association of Dentomaxillofacial Radiology."

US $65 per year or     US $150 for 3 years.
Payment:   Visa     MasterCard*     Amex   

Once the fees are paid no refund is possible
 MEGLAKOR is the vendor that processes internet and credit card transactions for
the Association and MEGLAKOR not IADMFR will appear on the member’s credit card statement


Card#                        
Name Card Holder  Exp.Date

* Visa and MasterCard users only: Number on reverse side of card (last 3 digits)

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