Midwest Dental Laboratory
Association, Inc.

2010 MDLA Membership Renewal

Active Member	Active membership consists of corporations, partnerships, and individuals operating dental labs in the states of MN, IA, NE, ND, SD or WI, as well as dental labs operated within these states that are branches of other out-of-state labs.  When both the home and branch offices or dental labs are located within one of these states, then only the home office will be accepted as an active member. Owner-Operators – those labs with the owner being the sole technician on the payroll - $125.00 per year Laboratories - any lab with tow or more technicians on the payroll - $175.00 per year
Affiliate Member	Affiliate membership shall consists of dental labs of University dental schools, noncommercial dental labs, schools of dental technology, manufacturers, suppliers, and retailers.  The cost of this membership is $125.00 per year.
Individual Technician or Individual Certified Dental Technician (C.D.T.) Member	Individual membership consists of individual technicians or CDTs who have no proprietary financial interest in a commercial dental lab.  Individual members may not be listed at a lab address or phone.  The cost of this membership is $50 per year.

Please enter your contact information below and be sure it reads as you wish it to appear in the MDLA 2010 Membership Directory.  If there is any information you don’t want published, please note it in the Comment area at the bottom of the form - we will use that information for MDLA use only.  It is especially important that we have at least one email address for your lab so we can communicate with you on a regular basis with updates on the association and the industry.  Please complete the form and make your dues payment no later than January 31, 2010 for inclusion in the Directory. The Directory will be provided to MDLA members, and members of the Minnesota Dental Association.