Nova Scotia Dental Assistants Association -

UPDATE INFORMATION ON RENEWAL

Please do not update your email address using this form. If you must update your email address, please contact the NSDAA office.

First Name*

Last Name*

Phone*

Street Address*

City*

Province*

Postal Code*

Dental Assisting School*

Birthdate (YY-MM-DD)*

Year of Graduation*

Employer

Employer Phone Number

Provincial Dental Board License Number

I give NSDAA permission to share my contact information with CDAA*

DO NOT UPDATE YOUR EMAIL ADDRESS USING THIS FORM - IT WILL CREATE A DUPLICATE ACCOUNT RECORD. CALL OR EMAIL THE NSDAA OFFICE IF YOU NEED TO CHANGE YOUR EMAIL ADDRESS.

Please note if paying by credit card, the credit card must be in your name (otherwise it updates your NSDAA record with the card holder's name and issues the receipt in their name). If someone else is paying your fee, please pay by e-transfer to nsdaa@eastlink.ca and please have them identify your name on the e-transfer so that the payment is credited to you.

Email [DO NOT EDIT - AND USE THIS EMAIL ON PAYMENT SYSTEM]*