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Classified Advertisement Submission Form
Once the classifieds submission form has been received, the submitter will receive an email with an electronic payment link for making a credit card payment.
*
1.
Please Select Your Membership Status
(Required.)
DCDS Member
DCDS Nonmember
Non-Profit Organization
2.
ADA Number
This field is required for DCDS Members only
3.
First Name
4.
Company/Organization
5.
Last Name
6.
Phone Number
7.
Email Address
8.
Are you a new dentist?
Yes
No
*
9.
Ad Category
(Required.)
Dental Positions
Dentist Seeking Employment
For Sale of Lease
Practice Transitions Opportunities
PSA
Other
10.
Please indicate where you would like for your ad to run:
Monthly E-Newsletter
Website
Both
11.
Please indicate which newsletter edition(s) you would like to advertise in:
January
February
March
April
May
June
July
August
September
October
November
December
12.
Ad Title
13.
Please type or paste your ad copy here
Limit of 300 characters (includes spaces and punctuation). Please do not include contact information in this text. We will add it for you.
14.
Contact Name
15.
Contact phone number
16.
Contact email address
*
17.
Please check the box to accept the terms
(Required.)
I accept