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.

Membership Form

Membership Information

Primary Doctor's Information

Office Address

Are you an ISDS member?

As an Illinois Dentist, you must be an ISDS member to join. To become a member or renew your ISDS membership, please visit: https://www.isds.org/member-center/join-renew.

Account Information

How would you like your account setup? (For multiple locations only)

Office Manager's Contact Information

Same as Doctor's Office

Ordering Person's Contact Information

Same as Office Manager's

Supplier Information

Current Supplier(s) *

Capital Equipment

Are you looking to purchase capital equipment in the next 12 months?
Estimated Time Frame of Equipment Needs

What types of equipment are you interested in purchasing?

Dental Operatory

Technology

Sterilization

Lab

Utility Room

Nitrous Needs

Referral Information

How did you hear about us? *
If you selected "Midway Dental", please indicate which Midway representative below.

Terms and Conditions

MSA *