IADR/AADOCR Applicant/Recipient/Competitor Information Form | IADR - International Association of Dental Research

Select Award Category

IADR Hatton Competition

SCADA

Other IADR/AADOCR Awards

Award Name

Awardee Info

Abstract Presenter

Yes

Abstract ID

IADR Member ID

IADR Division/Section

Name

First

Last

Email Address

University/Company [Will be used for Award Announcement]

Full Mailing Address [Will be used to ship award plaque and award payment if residing in U.S., if applicable.]

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Address will be used to ship award plaques, if applicable.

Emergency Contact

Emergency Contact Full Name

First

Last

Emergency Contact phone

Accessibility Needs, if applicable

Audio

Visual

Mobility

Do you need a VISA invitation letter (will be sent via email)

Yes

Traveler Information

Full Name as it appears on Passport

Birthdate (Month/Day/Year)

Passport Number

Nationality

Gender

Departure City, State, Country

Uploads

Photo Headshot

One file only.
64 MB limit.
Allowed types: gif, jpg, jpeg, png.

Recording of name pronunciation

(Instructions: In order to announce award winners, we want to confirm your name pronunciation. Please upload an audio file (.mp3) with you stating your name. You can record your audio using your cell phone or computer.

Cell phone users can use the native voice memo app or download a Voice Recorder app.
Computer users can use the audio recording function in a native Voice Recorder app.)

One file only.
64 MB limit.
Allowed types: mp3, ogg, wav, m4a, mov.

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