ACADEMY OF GENERAL DENTISTRY OF INDIA

AGDI
Invites You
To Practice General Dentistry Like Never Before
The Academy of General Dentistry of India is an association, dedicated to promote
continued proficiency of general dentists through quality dental education and training to
achieve excellence in oral health. The AGDI exclusively represents the interests of the
general dentists and serves their need for the most-up-to-date, valuable, relevant and
credible information, knowledge, education and training in general dentistry in the country.
The purpose is to advance the value and excellence in general dentistry through Fellowship
and Mastership Programs of the Academy. These programs are designed to suit the
continuing dental educational needs of a general dentist.
The Fellowship and Membership Programs of the Academy necessitate the accumulation
of the required CDE Credit Hours by attending CDE programs on different dental subjects
conducted by IAGD approved faculty followed by a written examination based on Multiple
Choice Questions. These programs ensure an advanced level of competency in the
participant in general dentistry. The Fellowship Program is the initial and the basic step to
acquiring this competency.
The Mastership Program of the Academy is available to general dentists who have
successfully completed the Fellowship Program. Besides the attendance and Examination
on Multiple Choice Questions, a practical examination is mandatory for the candidate for the
Mastership Program.
On successful completion of the Programs, the participant will be awarded certificates of
Fellowship and Mastership by the Academy in recognition of the high standard of excellence
and expertise of the general dentist.

Here's the opportunity to Achieve Excellence in Your Practice &

Be Counted among the Best in the Profession
ENROL AS A MEMBER OF THE ACADEMY TODAY
And ENJOY THE MANY PRIVILEGES AGDI HAS TO OFFER

Please fill in the enclosed Enrollment Form

You are invited to BE A SPEAKER/TRAINER
Should you wish to be on the Faculty Panel, Please mark in the enclosed Enrollment Form
with your preference for the subject that you would like to speak/lecture on with a copy of the
abstracts of your lecture/lectures and your curriculum vitae.
You also have the Privilege to work with Academy
Should you wish to work for the Academy, please let us know your interest in the enclosed
Enrollment Form. The Academy will have Chapters in every state, where you can make a
difference.
For Details
About the Academy and the Fellowship/Mastership programs
PLEASE CONTACT:

ENCODE
169-A,Mayur Niwas, Dr.Ambedkar Road, Dadar (East), Mumbai 400 014
Tel.No : +91-22-2414 5022 / 2415 0431 Fax : +91-22-24168708
Mobile: 98211 35850 / 99309 93933
E-mail dentistry@encodeindia.com Website: www.encodeindia.com

ACADEMY OF GENERAL DENTISTRY OF INDIA

AGDI
169-A, Mayur Nivas, Dr. Ambedkar Road, Dadar (E),
Mumbai 400 014. India.
Tel: 91-22-24145022 email: agdindia@gmail.com

Color
hotograph

ENROLMENT FORM
A. MEMBERSHIP
______

______________________________

Title

Name

_____

_______________________

MI

Surname

Date of Birth __ __ __ __ __ __ __ __
DD

Gender:

MM

YYYY

O Male O Female

Marital Status: _______________________

Business Address: _____________________________________________________________

_______________________________________________________ _____________________
City

State

Pin Code

Telephone:_______________________ email:_________________ website:________________________________

Communication Address: ________________________________________________________

_______________________________________________________ _____________________
City

State

Pin Code

Telephone:_______________________ mobile___________________________email:_______________________

Practice Details:
Reg.No.__________________ Starting Date:________________
Educational Qualifications: ______________ Year _____ Specialty: ______________________
College: _____________________________________________________________________
University: ___________________________________________________________________
Additional Qualifications: ________________ Year ____________
College: _____________________________________________________________________
University: ___________________________________________________________________
Professional Affiliations:
Post/s Held: _________________________________________________________________ Year____________
Post/s Held: _________________________________________________________________ Year____________
Post/s Held: _________________________________________________________________ Year____________
Post/s Held: _________________________________________________________________ Year____________

------------------------------------------------------------------------------------------------------------------------------------------------------------

B. SPEAKER/TRAINER
Lectures/Courses Conducted: (Begin with the recent)
Date Topic
Duration
Place
1.
2.
3.
4.
5.
6.
Topic/Speciality of Interest: _________________________________________________
Attach a copy of Abstract of your Lecture/Course and Curriculum Vitae.
------------------------------------------------------------------------------------------------------------------------------------------------------------

C. CO-ORDINATOR/MEMBER, ORGANIZING COMMITTEE

Memberships & Posts Held in Dental Associations/Institutions:

1._____________________________________________________________________
2._____________________________________________________________________
3._____________________________________________________________________
4._____________________________________________________________________
5._____________________________________________________________________
Are you interested in working for AGDI. Please mark your preference
1. At the State Level
2. At the City Level
3. At the Town Level

Y/N
Y/N
Y/N
Please fill in all the details and send it to:
Academy of General Dentistry of India
at

ENCODE
169-A,Mayur Niwas, Dr.Ambedkar Road, Dadar (East), Mumbai 400 014
Tel.No : +91-22-2414 5022 / 2415 0431 Fax : +91-22-24168708
Mobile: 98211 35850 / 99309 93933
E-mail dentistry@encodeindia.com Website: www.encodeindia.com