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ACADEMY OF GENERAL DENTISTRY OF INDIA
AGDI
Invites You
To Practice General Dentistry Like Never Before
The Academy of General Dentistry of India is an association,
dedicated to promote
continued proficiency of general dentists through quality dental
education and training to
achieve excellence in oral health. The AGDI exclusively
represents the interests of the
general dentists and serves their need for the most-up-to-date,
valuable, relevant and
credible information, knowledge, education and training in
general dentistry in the country.
The purpose is to advance the value and excellence in general
dentistry through Fellowship
and Mastership Programs of the Academy. These programs are
designed to suit the
continuing dental educational needs of a general dentist.
The Fellowship and Membership Programs of the Academy
necessitate the accumulation
of the required CDE Credit Hours by attending CDE programs on
different dental subjects
conducted by IAGD approved faculty followed by a written
examination based on Multiple
Choice Questions. These programs ensure an advanced level of
competency in the
participant in general dentistry. The Fellowship Program is the
initial and the basic step toacquiring this competency.
The Mastership Program of the Academy is available to general
dentists who have
successfully completed the Fellowship Program. Besides the
attendance and Examination
on Multiple Choice Questions, a practical examination is
mandatory for the candidate for the
Mastership Program.
On successful completion of the Programs, the participant will
be awarded certificates of
Fellowship and Mastership by the Academy in recognition of the
high standard of excellenceand expertise of the general
dentist.
Here's the opportunity to Achieve Excellence in Your Practice
&Be Counted among the Best in the Profession
ENROL AS A MEMBER OF THE ACADEMY TODAY
And ENJOY THE MANY PRIVILEGES AGDI HAS TO OFFER
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Please fill in the enclosed Enrollment Form
You are invited to BE A SPEAKER/TRAINER
Should you wish to be on the Faculty Panel, Please mark in the
enclosed Enrollment Form
with your preference for the subject that you would like to
speak/lecture on with a copy of the
abstracts of your lecture/lectures and your curriculum
vitae.
You also have the Privilege to work with Academy
Should you wish to work for the Academy, please let us know your
interest in the enclosed
Enrollment Form. The Academy will have Chapters in every state,
where you can make a
difference.
For Details
About the Academy and the Fellowship/Mastership programs
PLEASE CONTACT:
ENCODE169-A,Mayur Niwas, Dr.Ambedkar Road, Dadar (East), Mumbai
400 014
Tel.No : +91-22-2414 5022 / 2415 0431 Fax : +91-22-24168708
Mobile: 98211 35850 / 99309 93933
E-mail [email protected] Website:
www.encodeindia.com
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ACADEMY OF GENERAL DENTISTRY OF INDIA
AGDI169-A, Mayur Nivas, Dr. Ambedkar Road, Dadar (E),Mumbai 400
014. India.Tel: 91-22-24145022 email: [email protected]
ENROLMENT FORM
A. MEMBERSHIP
______ ______________________________ _____
_______________________Title Name MI Surname
Date of Birth __ __ __ __ __ __ __ __
DD MM YYYY
Gender: O Male O Female Marital Status:
_______________________
Business Address:
_____________________________________________________________
_______________________________________________________
_____________________
City State Pin Code
Telephone:_______________________ email:_________________
website:________________________________
Communication Address:
________________________________________________________
_______________________________________________________
_____________________
City State Pin Code
Telephone:_______________________
mobile___________________________email:_______________________
Practice Details:
Reg.No.__________________ Starting Date:________________
Educational Qualifications: ______________ Year _____ Specialty:
______________________College:
_____________________________________________________________________
University:
___________________________________________________________________
Additional Qualifications: ________________ Year____________
College:
_____________________________________________________________________
University:
___________________________________________________________________
Professional Affiliations:
Post/s Held:
_________________________________________________________________
Year____________
Post/s Held:
_________________________________________________________________
Year____________
Post/s Held:
_________________________________________________________________
Year____________
Post/s Held:
_________________________________________________________________
Year____________
Color
hotograph
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B. SPEAKER/TRAINER
Lectures/Courses Conducted: (Begin with the recent)
Date Topic Duration Place
1.
2.
3.
4.
5.
6.
Topic/Speciality of
Interest:_________________________________________________
Attach a copy of Abstract of your Lecture/Course and Curriculum
Vitae.
------------------------------------------------------------------------------------------------------------------------------------------------------------
C. CO-ORDINATOR/MEMBER, ORGANIZING COMMITTEE
Memberships & Posts Held in Dental
Associations/Institutions:1._____________________________________________________________________
2._____________________________________________________________________
3._____________________________________________________________________
4._____________________________________________________________________
5._____________________________________________________________________
Are you interested in working for AGDI. Please mark your
preference
1. At the State Level Y/N
2. At the City Level Y/N
3. At the Town Level Y/N
Please fill in all the details and send it to:
Academy of General Dentistry of India
at
ENCODE169-A,Mayur Niwas, Dr.Ambedkar Road, Dadar (East), Mumbai
400 014
Tel.No : +91-22-2414 5022 / 2415 0431 Fax : +91-22-24168708
Mobile: 98211 35850 / 99309 93933
E-mail [email protected] Website:
www.encodeindia.com
