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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 (optional)
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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
Upload ADHA Membership Card:
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Continuing Education (CE) Course Listing Option1:
Minimum of fifteen (15) 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. Complete the following table or simply upload your course file below.
Continuing Education (CE) Course Listing Option 2:
You may choose to upload your CE course list here. You must use the same headings (Date of CE, # of CE Credits, Course Title, Location (live webinar, etc), Speaker(s), Sponsor.
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
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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the form.
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