Registration Confirmation - College of Dental Surgeons of Alberta

I,

Name*

Prefix First Last

wish to register with the following status:

Registration Status*

Full Practice Register
Registered Only
New Graduate
Half-Year Pro-Rated Fee

Registration Fee: $1,000.00
Practice Permit Fee: $3,635.00
Professional Liability Insurance: $1,415.00
TOTAL: $6,050.00

Registration Fee: $1,000.00
Practice Permit Fee: $2,100.00
Professional Liability Insurance: $709.00
TOTAL: $3,809.00

Registration Fee: $1,000.00

Full Register - Fees assessed from January to June 30, 2022 are $6,050.00 for
applicants who have been previously registered in another jurisdiction. ($3,635.00 practice
permit fee, $1,415.00 professional liability insurance and $1,000.00 registration fee)

Half Year / Pro-rated Register – Half Year fees assessed from July 1 to December 31, 2022 are $3,809.00 for applicants who have been previously registered in another jurisdiction. ($2,100.00 practice permit, $709.00 professional liability insurance fee and $1,000.00 registration fee)

New Graduate Register - Fees assessed are a total of $3,809.00 for applicants who have not been previously registered in another jurisdiction ($2,100.00 practice permit fees, $709.00 professional liability insurance fee and $1,000.00 registration fee)

Specialists - Are assessed an additional one-time registration fee of $300.00 to register as their
specialty in addition to the registration and practice permit fees.

Registered Only - Is available for those that are not planning to practice right away. Please note that with the Registered Only status any Certificate of Standing or Letters of Good Standing will stale-date 8 weeks from the date of issuance. It is the responsibly of the applicant to ensure that any Certificates of Standing or Letters of Good Standing on their application are current at the time of full practice registration.

Please note the calendar year in Alberta is January 1 to December 31.

All fees paid are non-refundable and subject to change, based on Council decision.

Name*

Prefix First Last

Date*

Confirm*

By submitting this form electronically, I acknowledge and agree that the contents are true and complete as if I had signed the document in writing. I declare that the contents of this form are true and complete and I understand and agree that if I make a false or misleading statement or representation in my registration, I will be deemed to not have satisfied the requirements of registration. I further understand and agree that making a false or misleading statement to the Alberta Dental Association and College may constitute unprofessional conduct.