Purchase of a Roster
Rosters
which include the names and addresses of licensees are available for purchase
according to the following procedures:
-
Complete all sections of the order form. Missing specifications may result in delays in processing your order.
-
The signed Purchase of Roster Agreement must be returned to this office with the completed order form. The agreement affirms that the materials or publications to be disseminated shall not be published in a manner which could be construed by the public to mean that the Board supports, endorses, or approves of the materials disseminated. Be sure to include your street address on the Purchase or Roster Agreement.
-
Payment shall be received prior to release of a roster.
-
Turn around time for processing an order is minimum of 10 working days.
COST
INFORMATION
Standard mailing lists include:
-
Full Name
-
Address
-
City
-
State
-
Zip Code.
Printed mailing list: $65.00 per profession.Mailing list on diskette or CD-Rom: $45.00 per profession.Mailing list in an electronic file: $35.00 per profession.
Standard data lists include:
-
full name
-
address
-
city
-
state
-
zip code
-
issue date
-
license or registration number
-
expiration date
-
license or registration status.
Printed standard data list: $75.00 per profession.Standard data on diskette or CD: $55.00 per profession requested.Standard data in an electronic file: $45.00 per profession requested.Additional data elements, programming or sorting increases the fees by $25.00.
PURCHASE OF ROSTER ORDER FORM
If you wish to purchase a roster, please print this document and complete the information requested below and return it to the Iowa Dental Board with the signed Purchase of Roster Agreement.Type of Roster
_____Printed mailing list: $65.00 per profession.
_____Mailing list on diskette or CD-Rom: $45.00 per profession.
_____Mailing list in an electronic file: $35.00 per profession.
_____Printed standard data list: $75.00 per profession.
_____Standard data list on diskette or CD: $55.00 per profession.
_____Standard data list in an electronic file: $45.00 per profession.
Format of roster:
_____ Pressure sensitive labels: Avery 5261 address labels
_____ Printed List
_____ 3.5 inch, high density diskette Formatted IBM Compatible
_____ Electronic file via E-mail
_____ CD-Rom
Type and status of license:
_____ Dentists - Active
_____ Dental Hygienists - Active
_____ Registered Dental Assistants* – Active
Geographic Area:
_____ In-State Licensees/Registrants Only
_____ All Licensees/Registrants (In-State and those residing outside Iowa)
_____ Specific Iowa counties (list the counties by name)
Printing sequence:
_____ Zip code
_____ Alphabetical by last name of licensee
_____ Other ___________________________________________________________
The standard list does not include resident or faculty permit holders, or the following license/registration statuses: Lapsed, revoked, retired, surrendered, deceased, inactive, not renewing or disciplinary actions.Additional data elements, programming or sorting increases the fees by $25.00.
We are unable to provide social security numbers, graduation school, and graduation year.*The standard data list for dental assistants will distinguish between dental assistants who are registered, and dental assistants who are registered and also hold an added qualification in dental radiography.
PURCHASE OF ROSTER AGREEMENT
By
signing this form:
I
verify having full knowledge and understanding that materials/publications
to be disseminated using a roster of names and addresses of licensed dentists,
dental hygienists, or registered dental assistants, shall not be published
in any manner which could be construed by the public to mean that the
Iowa Dental Board or any of its employees supports, endorses,
approves, etc., the materials/publications to be disseminated.
I
acknowledge that I am placing an actual order for a roster of Iowa dental,
dental hygiene licenses, and dental assistant registrants. I understand that the Iowa Dental Board must receive payment before my request can be processed.
Name
(typed or printed) _______________________________________
Signature:
__________________________________________________
Firm
Name _________________________________________________
Address
____________________________________________________
___________________________________________________________
Email Address:
______________________________________________
Phone: _________________________ Date: ______________________
Please
attach this form to the purchase of the roster order form being returned
to the Iowa Dental Board, along with payment in the form of a check or money order.
Your order cannot be processed without a signature on this form.
Iowa Dental Board
400 SW 8th St., Suite D
Des Moines, IA 50309-4687
Fax: 515/281-7969