The Directors, members and staff of the Australian Dental Industry Association (ADIA) welcome your interest in becoming part of a growing community of businesses that  supply products and services to dental professionals.

This application form for ADIA Corporate Membership is for businesses that manufacture and supply dental products which appear on the TGA Australian Register of Therapeutic Products.

With respect to the Applicant, it is declared that:

(a)     The business manufactures and / or suppliers therapeutic goods in accordance with the requirements of the Therapeutic Goods Act (Cth) 1989 ;

(b)     That the applicant will comply with the Therapeutic Goods Advertising Code 2007.

Furthermore, with respect to the products manufactured and /  or supplied by the Applicant the following Australian Register of Therapeutic Product (ARTG) entry is correct:

This information is required to calculate your business’ annual  membership fee. The response is confidential and not published or disclosed to Directors or members. ADIA may verify the  turnover using ASIC, corporate reporting or corporate credit files.

With respect to the Applicant, it is declared that in the  preceding five (5) years the applicant, its directors and senior management have not been:
(a)     Convicted of an offence involving fraud, dishonesty or theft;
(b)     Declared bankrupt or an undischarged bankrupt;
(c)     A director of a company placed into liquidation or entered into an arrangement with its creditors for the relief of its debts;
(d)     Convicted of a breach of the Therapeutic Goods Act (Cth) 1989 or received a civil penalty for a breach of the same;
(e)     Convicted of a breach of the Corporations Act (Cth) 2001.
and that the Applicant will abide by the ADIA Code of Practice for the duration of membership and as otherwise contractually required.