Installment Program & Auto Renew Payment Program

Electronic Dues Payment Program

Authorization Agreement

I authorize the Illinois State Dental Society (“ISDS”), an Illinois non-for-profit corporation, to initiate automated debits to the credit card shown below. This authorization includes all adjusting entries, either debit or credit, that may be required.

I agree to pay all such Dues amounts owed and designed by me. If, for any reason, my credit card is revoked, suspended, halted by me or the credit card cannot be processed for any other reason, I remain responsible for paying the Dues installment owed directly to ISDS on a timely basis. If a credit card payment debit cannot be processed, ISDS is authorized to attempt to initiate the debit again at a later time. If, for any reason, a debit is repeatedly dishonored. ISDS in not liable for any losses incurred by reason of any failure in the automated debit process. I am responsible for any fees that may be imposed by my credit card issuer. If my credit card cannot be processed on any two debit dates, ISDS may terminate the automated debits by giving me written notice at my address as shown in ISDS’s records. My membership shall not be considered in good standing until all past Dues amounts owed are considered current.

I may terminate automated credit card debits by notifying ISDS by calling 800-475-4737 and the termination will be effective seven business days after the date the notice is received by ISDS. Following any termination of automated credit card debits by either ISDS or me, I will be responsible for paying my remaining Dues in full, directly to ISDS.

No refunds will be provided for canceled memberships. By enrolling in a membership, I understand that a “membership year” spans a calendar year from January through December and not a twelve-month period from the date of enrollment. This authorization shall be governed by and interpreted in accordance with the laws of the State of Illinois, without giving effect to any choice of law rule that would cause the application of the laws of any other jurisdiction to the rights and duties of the parties.

Installment Payment Program Agreement

If I elect to enroll in the installment payment program, I understand that for each membership year, defined as January through December: if I enroll prior to January 5^th of such membership year, the first debit shall be made on the 15^th day of January; if I enroll after January 5^th of such membership year, and such date falls on any of first through 5^th days of the current month, my first debit will be on the 15^th day of the month that I enroll. In any event, subsequent debits shall be made on the 15^th day of each succeeding month through December of the membership year. If the scheduled date of a debit falls on a weekend or a legal or business holiday, the debit will occur on the next business day. In enrolling in the Installment Payment Program, I am thereby agreeing to the Electronic Dues Payment Program Authorization Agreement as detailed above.

If I enroll prior to January 5^th, each monthly debit shall be in an amount approximately equal to one twelfth (1/12) multiplied by the sum of the total tripartite and voluntary dues for the membership year to ISDS, American Dental Association, my local component society and other recipients designated by me (“Dues”). If I enroll after January 5^th, the first monthly debit will be the cumulative monthly amount required to bring the monthly payments current and subsequent monthly debits shall be equal to one twelfth (1/12) multiplied by the sum of the total tripartite and voluntary dues for the membership year to ISDS, American Dental Association, my local component society and other recipients designated by me (“Dues”).

Auto Renew Payment Program Agreement

By electing to enroll in the Auto Renew Payment Program in conjunction with installment payments, or as a once-per-year automatic payment of membership dues and/or voluntary dues items, I am thereby agreeing to allow an automatic renewal of my membership in future years. This includes the same terms and conditions as detailed above for the Electronic Dues Payment Program Authorization Agreement and Installment Payment Program Agreement (if enrolling in installments). In lieu of receiving a dues statement in future years, I understand I will receive an auto-renewal letter providing information on next year’s membership dues rates and/or voluntary items that I have elected to be enrolled in the Auto Renew Payment Program, and how I can change voluntary contributions or stop the auto renew feature. I agree to provide notice of cancellation in writing of the auto renew payment plan for the proceeding membership year that must be postmarked no later than December 15^th. This notice in writing must be sent to the following address:

Illinois State Dental Society
3100 Montvale Drive
Springfield, IL 62704

Any questions? Please contact us at 800/475-4737.