Membership Form

Please fill out the following form. Once we have received your member application, you will receive an email with our welcome packet that provides instructions on how to begin saving and taking advantage of your membership.

If you are an Illinois practice, please note you must first be an ISDS member to join IDS.

Please also review our IDS Member Services Agreement (MSA).

‚ÄčIf you have questions or need assistance with the form, please contact us.


Primary Doctor's Information

Office Address

If you have multiple practices, please provide the address information for all practice locations below.
Address Line 1
Address Line 2
Are you an ISDS member?

As an Illinois Dentist, you must be an ISDS member to
join. To become/renew your ISDS membership, please visit:

Zip Code

Office Manager's Contact Information

Ordering Person's Contact Information

Supplier Information

Are you looking to purchase capital equipment in the next 12 months?

Capital Equipment

What types of equipment are you interested in purchasing?
Dental Operatory
Utility Room
Nitrous Needs
Estimated Time Frame of Equipment Needs

Referral Information

If you selected "Other", please indicate how you heard about us in the comments section below.
Are you a paid-MDIB member?

There are additional benefits if you join as a paid-MDIB member, please see the details here.

Do we have your permission to share that you joined on our Facebook page to welcome you to the family?
If you consent, we will tag your practice's Facebook page on the post if available.

Terms and Conditions