Please complete this Application for Fellowship in the International Academy for Dental-Facial Esthetics. Payment must be made at the time of application on/or before November 12, 2026.

To complete your Application, please pay New Fellowship fees on the IADFE website: https://iadfe.org/new-fellows.php

The New Fellow Dinner will be held Monday November 30th, 2026 at 5:15 PM at the Harmonie Club (4 East 60th Street, New York, NY). Additional guests are welcome at a cost of $150.00 per person.

If you encounter problems with the payment portion, please contact the Executive Director at iadfeorg@gmail.com.

APPLICATION FOR FELLOWSHIP — BIOGRAPHICAL PROFILE
(*) denotes a required field

1. Personal Information
Family name (*)
First name (*)
Office Address (Number, Street)
City
State
Postal Code
Country
Telephone
WhatsApp
E-mail (*)
Date of birth (Y/M/D)
Place of birth
2. Education

Please include Institution/Location, Date, and Degree/Certificate.

Pre-dental/medical School(s)
Dental/Medical School(s)
Graduate School(s)
Residency
3. Current Professional Activity
Private Practice %      Academia %      Other Activities %  
Clinic name
Clinic website
School name
School Title
Research Institution
Research Institution Title
Hospital Appointment(s) and Title(s)
4. Licensure and Specialty Certification
Licensure: State(s) and National
Specialty Board(s)
5. Professional Career History
Previous practice, teaching/research activities. Position/Activity, Year: From – To
6. Scientific/Professional Organizational Involvement
Organization, Leadership positions/Activities, Year
7. Cultural and Community Involvement
Organization, Leadership positions/Activities, Year
8. Publications
Title, Journal/Publisher, Year
Total number of publications
9. Presentations: Papers and Clinics
Title, Subject, Organization/Site, Year
Total number of presentations
10. Honors and Awards
Title, Organization, Year
11. Languages
Please list languages spoken
12. Additional Information
Please include additional information about your special skills, interests, and accomplishments.
New Fellow Dinner

Monday November 30th, 2026 at 5:15 PM at the Harmonie Club (4 East 60th Street, New York, NY).
Fellowship Fee: $550.00 — Additional guests are welcome at a cost of $150.00 per person.
Please pay New Fellowship fees at https://iadfe.org/new-fellows.php.

I will be attending the 2026 New Fellow Dinner
  
Number of Guests @ $150.00/person
Please note any religious dietary restrictions for you or your guests