Member Application

New Member Application

Thank you for your interest in becoming a member of organized dentistry.The American Dental Association and your state and local dental societies have a tripartite membership structure. Therefore, final approval of your application provides you with membership at all three levels of your professional associations: local, state and national. Your application will be processed and considered by your state or local society, which will provide you with additional information regarding their specific application procedures. Please apply to the society where you conduct or will conduct the major portion of your practice; your state or local society may request additional information. For complete information regarding the Bylawsand the Principles of Ethicsand Code of Professional Conductof the ADA which govern the professional conduct of members, please see our website at http://www.ada.org/ada/governance/index.asp. A list of state dental societies accompanies this application.

Please print the PDF below and complete all sections of this application.