CONFIRM MEMBERSHIP LEVEL
Membership Type
OPT-IN TO AUTO-RENEWAL
If you'd like your membership to auto-renew each year, please select the check box below. If you'd like to manually renew each year, leave the check box below unchecked.
PERSONAL INFORMATION
Practice Name
First Name
Last Name
Job Title
Preferred Email
Work Phone
Cell Phone
Practice URL
Work Address
Address Line 2 (Suite, Number, etc.)
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip
-
Zip Suffix
How did you hear about SOMSA?
Predecessor at practice
My doctor
A vendor/supplier we work with
Terri Bradley Consulting
Internal referral (e.g. DSO/MSO membership)
AAOMS Annual Meeting/Mixer
OMSNIC
Online Search (Google, Bing, etc.)
Flyer/Postcard
Email
Fax
SW Society Meeting
Other Meeting or Event
Friend or Acquaintance
Carestream Dental Users Meeting
Marketing phone call
IDIA Newsletter
Referral Source: If a SOMSA member told you about our Society, give them referral credit by entering their name here
PRACTICE INFORMATION
We have received regular requests from members to be able to search for other members by several aspects of practice characteristics. Please provide the information below so members with similar practices can connect with you!
DEFINTIONS
-Practice Type: How would you classify your practice. If you feel your practice type is not represented, please select the best option below, then email Linden describing your practice classification for consideration.-Number of Surgeons: How many doctors does your practice currently have-Surgeon Names: Please list your doctors' names, separated by a comma-Number of Offices: How many locations are included in your practice-Total number of Full-Time Equivalencies: Not including yourself, what is the equivalent to full time employees does your practice have. Example: If you have 10 full time and 12 part time employees, you would enter 16 FTEs.-Practice Software: What practice software does your practice use? If you do not see your software listed, please select the best option below, then email Linden your practice software (e.g. Oral Surgery Exec) and maker (e.g. DSN).-Professional Certifications: List any professional certifications you'd like to share with members-Years in OMS: How long have you been working in the OMS field, administratively or otherwise-How did you hear about SOMSA?: Let us know how you heard about us! Please choose the best option.
Practice Type
OMS Private Practice
OMS University Affiliated
OMS Hospital based/owned
Other: OMS industry partner
Number of Surgeons
Surgeons Names
Number of Offices
Total number of Full-Time Equivalencies
Practice Software
WinOMS (Carestream)
WinOMS Sensei Cloud (Carestream)
DSN
DSN Cloud
OMSVision (Henry Schein)
Windent OMS (Carestream)
MEDIMS (Nectech)
Open Dental
Other - Cerner Medical - EHR
Other - Eaglesoft
Other - MacPractice
Other - NextGen
Other - PBYTE
Other - QSI
various systems
Professional Certifications
Years in OMS
CREATE YOUR SOMSA ACCOUNT
If you would like to manage your Society of OMS Administrators account (i.e., view donation history, renew membership, etc.), please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.
