Membership application

Fill in your details, choose a plan and set up the recurring dues payment with PayPal. The office reviews every application.

Plan and payment

Year you were licensed

How do you want to pay?

Personal details

First name (Hebrew) *

Last name (Hebrew) *

First name (English) *

Last name (English) *

ID number *

License number *

Email *

Confirm email *

Mobile phone *

Additional phone

Clinic phone

Website

Specialty

Dental school

Graduation year

Mailing address

Street and number

City

Postal code

Country

Clinic address

Same as the mailing address

Declarations

I request to join Alpha Omega Israel as a member.The details I have given are accurate.I understand that my dues (₪600) are charged automatically every year until I cancel, and that I can cancel at any time from the members' area; membership then continues until the end of the period already paid.Send me news and event announcements by email and SMS.

You'll approve the recurring payment on PayPal, then come back here.