First Name

Last Name

Mailing Address

City

Province ProvinceSaskatchewan

Postal Code

Cell Phone

Email

Saskatchewan RDA #

Are you a student? Are you a student? Yes No

I agree that I have been advised that the Society of Saskatchewan Dental Assistants cannot provide me with complete services unless this form is on file with all the requested information provided? * I agree that I have been advised that the Society of Saskatchewan Dental Assistants cannot provide me with complete services unless this form is on file with all the requested information provided? * Yes

I accept that information provided to the SSKDA by our members will only be used for association related business. Any information provided will be used in the reasonable and usual conduct of association business including but not limited to: Newsletters, Board and Committee business, Continuing Education, Events Registration, Awards and Recognition. Unless specifically notified by an individual member of specific information that is not to be used for a specific purpose, the member gives the SSKDA permission to use any information on file for the reasonable and usual conduct of association related business? * I accept that information provided to the SSKDA by our members will only be used for association related business. Any information provided will be used in the reasonable and usual conduct of association business including but not limited to: Newsletters, Board and Committee business, Continuing Education, Events Registration, Awards and Recognition. Unless specifically notified by an individual member of specific information that is not to be used for a specific purpose, the member gives the SSKDA permission to use any information on file for the reasonable and usual conduct of association related business? * Yes

I agree to the use of the following information by the SSKDA for the reasonable and usual purposes of conducting the business of the association. I understand that it is my responsibility to advise the SSKDA directly of any change to this information when it occurs. I understand that failure to do so may result in loss of benefits or services relying on this information? * I agree to the use of the following information by the SSKDA for the reasonable and usual purposes of conducting the business of the association. I understand that it is my responsibility to advise the SSKDA directly of any change to this information when it occurs. I understand that failure to do so may result in loss of benefits or services relying on this information? * Yes