At this point we are only accepting applications in Ontario, Canada and Utah, USA.
Do you have a regular dentist?
Please identify the state of your dentition, please try to be as specific as possible.
Do you have dental insurance?
How long have you missing your teeth ---Please Select---Less Than One Year1-5 Years5-10 Years10+ Years
"Grant Applicant / Recipient Agreement
Date of Board Approval: September 1, 2013
As an applicant, or potential recipient of a grant from the ISOR, I agree to the following terms:
1. I understand that although many patients have been helped out towards getting the care they need, that there are no guarantees that I am deemed to be eligible to be considered for the treatment, or to receive a grant.
2. I certify that any funds which may be disbursed to me by the ISOR will be used only for the purpose of an implant dental treatment plan.
3. Should I not undertake the procedure within 3 months of receipt of the Grant, I will forfeit the award.
4. I am responsible for informing the ISOR of any change or changes in my name or address during the period of time comprised of applying for an Implant Dentistry Grant, and receipt of any Grant that may be awarded.
5. I agree that ISOR may provide my information to authorized dental practitioners, their respective staff, third-party agents, volunteers or subsidiaries, for the purpose of booking my assessment and consultation, and to communicate with me regarding the status of my grant application; and/or to perform functions such as customer service, etc.
6. I agree to allow the ISOR to publicize the disbursement of funds to me without prior notification to me. (We will not identify the nature of your treatment.)
7. I agree that the ISOR may use my name, as well as other independently gathered information about me that is already in the public domain.
8. I am aware that this includes, but is not restricted to, publication in the ISOR Newsletter, Corporate Sponsorship campaign advertisements, letters and brochures.
9. If I am awarded a Grant, I will write a thank-you letter to the Organization that acknowledges the award. The Grant proceeds will not be awarded unless/until a thank-you letter is received.
10. I certify that I am at least 18 years of age.
Submitting an application for an Implant Dentistry Grant confirms you have read, understand and agree to the terms of these guidelines and agree to comply with them."
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