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Initial Membership Application
Thank you for your interest in becoming a member of the American Academy of Dental Hygiene Inc.! We look forward to reviewing your application. Submission of application is not a guarantee of membership. All applications are screened by the Membership Committee and then forwarded to the Governing Council for final approval. You will receive notification of final membership status. This process may take up to 4-6 weeks. If you have questions regarding the application process email Danni Gomes at admin@aadh.org.
Application Fees:
$35.00 Non-ADHA Member $25.00 ADHA Member
Membership Dues:
Upon membership approval you will be required to pay the following membership dues. $175.00 Non-ADHA Member $125.00 ADHA Member
Submission requirements checklist:
Date of Application:
Today's Date
Name:
First Name
Last Name
Credentials:
Credentials
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SMS Number:
-
Area Code
Phone Number
Email Address:
Please avoid using an email address ending in .edu so our emails won't get blocked
Birthdate: (optional)
-
Month
-
Day
Year
Date
How did you hear about AADH?
Friend
Website
Colleague
Convention
Social media
Other
Who should we thank for referring you?
Please provide 3-5 lines describing your career philosophy and/or experiences.
*
Upload headshot (optional) *used to recognize you on our website and/or social profiles.
Enter Instagram username here (if applicable) so we can tag you on post
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Education:
*
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Professional Credentials & Affiliations:
Dental Hygiene License Number
*
Upload current licensure or registration
*
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List additional licenses in other states. (i.e. #22323 MI, 33993 OH,)
Are you an ADHA member?
Yes
No
ADHA Member #
Constituent:
Upload ADHA Membership Card:
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Curriculum Vitae/Resume:
*
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Professional Career Experience:
Please provide the following information for each applicable experience:
*
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Continuing Education Course Listing:
Continuing education is defined as non-degree credit bearing courses for adults, regardless of previous education, offered by a university, institute or provider which is recognized as adjunctive or belonging to the practice of dental hygiene. Minimum of seventy-five (75) credits are required, that must meet AADH course approval requirements and/or other CE official approving organization (i.e. ADA, PACE). Only twenty-five (25)% of the total hours can be given by the applicant. YOU MUST USE THE FOLLOWING HEADINGS: (DATE of CE, # of CE CREDITS, COURSE TITLE, LOCATION (LIVE WEBINAR, ETC.), SPEAKER(s), SPONSOR, FAILURE TO DO SO, WILL CAUSE YOUR APPLICATION TO BE DENIED. Please upload your CE Course list below.
Upload CE Course List:
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Non-refundable Membership Application Payment:
Please submit the appropriate payment below.
Please be sure that ONLY 1 option is selected before proceeding.
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AADH Membership Application Fee
$
35.00
Non-ADHA Member
AADH Membership Application Fee
$
25.00
ADHA Member
Total
$
0.00
Payment Methods
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Last Name
Credit Card Number
Security Code
Card Expiration
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