We hereby apply for membership in the
Dental Laboratory Owners Association of California.

Owners Name 
Name of Laboratory
Street Address
City 
State 
Zip Code
Telephone 
Fax 
E-mail 
Does your laboratory have a web site?
if so, what is its URL
Sales Tax permit No.
Business License No. 
Total Number of Technicians (do not include yourself or partners)
Check the following work performed in your laboratory:

Dentures    Partial Dentures    Crown & Bridge    Porcelain    Orthodontic    Chrome    Full Service


In making this application, we agree to abide by the rules and regulations of this Association, its Code of Ethics and all laws, ordinances, or public regulations concerning the dental laboratory industry. Initiation Fee: $40.00

Monthly Dues and Assessments: $32.50 plus $1.00 per technician

Program Account $10.00 per year. Appears on January statement