Please be assured that your personal information is kept private. We do not share our information with any other sources. All information that you provide to us is for use only for the First District Dental Placement Program.

Login Information You will use your email address and password to log in to the web site.
Email
Password	4-10 numbers or case-sensitive letters Please confirm your password
	I own the practice for which I am seeking an associate or employee.
ADA Number	Do not enter spaces or dashes.
First Name
Last Name
Practice or Company Name
Address
City, State Zip	CTMAMENHRIVT
Phone	Primary Alternate
Fax
Preferred method of contact	Primary Phone Alternate Phone Email Fax Mail
Brief description of your practice: You will be able to list any available positions and their descriptions on the next page.
Mailing List	Please add me to your mailing list to be notified of site updates. You will automatically be emailed new prospective employee information when there is a match.
Consent	I hereby consent that the above information is correct. Checking this box serves as your signature.