Membership Renewal Application
Thank you for your interest in renewing your membership with the American Academy of Dental Hygiene Inc.! We look forward to continuing to support you in this wonderful profession. You will receive notification of final membership status. If you have questions regarding the renewal process email Danni Gomes at admin@aadh.org.
Annual Membership Dues:
$175.00 Non-ADHA Member $125.00 ADHA Member
Submission requirements checklist:
Date:
Today's Date
Name:
First Name
Last Name
Credentials:
Credentials
Address:(If changed)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
-
Area Code
Phone Number
Email Address:
Please avoid using an email address ending in .edu so our emails won't get blocked
Upload headshot if you haven't sent one previously.(optional) *used to recognize you on our website and/or social profiles.
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Professional Credentials & Affiliations:
Dental Hygiene License Number
Licensure Attestation
By signing below, I attest that my dental hygiene license(s) are current and in good standing.
Signature of attestation:
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
Upload ADHA Membership Card:
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Continuing Education (CE) Course Requirements:
Minimum of fifteen (15) credits are required, that must meet AADH course approval requirements and/or other CE official approving organization (i.e. PACE). Only twenty-five (25%) of the total hours can be given by the applicant. By signing below I attest that I have completed the 15 CE credits requirement and that I am aware that I may be audited by the Governing Council. Upon an audit, failure to submit the required CE credits in a timely manner will forfeit my membership privileges.
Signature of attestation:
Upload CE Course List:
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Membership Renewal Payment:
Please submit the appropriate payment below.
Select 1 option:
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AADH Membership Renewal Dues
$
175.00
Non-ADHA Member
AADH Membership Renewal Dues
$
125.00
ADHA Member
Total
$
0.00
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
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the form.
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