PCDA Contact Information Update and Dues

Update Contact Information and Pay Dues

Affiliate Membership requires you to be a member, in good standing, of the American, Florida and West Coast District Dental Associations.
Name*

First NameLast Name
Email*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Please enter a valid phone number.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/Cell Phone
Please enter a valid phone number.
Preferred Mailing*

BusinessHome
Would you like to pay regular dues or pay by meeting?*

Pay regular duesPay by meeting

Membership Dues 2025-2026

Active Member

$350.00

Public Health Employee

$300.00

Life Member/Retired

Choose this option if you are a Life Member of the ADA, FDA & WCDDA. A Life Member is: 62 years of age and 40 total years of membership or 30 consecutive years of membership in the ADA.

$175.00

Dental Service Project Fund Donation

Supports local projects in the community such as More Health, Inc. Suggested donation amount: $50 - $100

$ Free Donation Amount

Dr. Betty Hughes Fund for Advancement of Dentistry

Supports 1st time attendees to Dentists' Day on the Hill. Suggested donation amount $50-$100

$ Free Donation Amount

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
Should be Empty:

Update Contact Information and Pay Dues