FACD Membership Renewal

Your Membership Benefits Include:

Discounted Registration to the FACD Annual Session – August 26-28, 2027 in Orlando, FL.
Exclusive Access to the FACD Hands-On Course – April 30, 2027 in Tampa, FL.
Discounted Reigstration to the AACD Annual Scientific Session if you are also an AACD Member - March 31 - April 3 in Hollywood, FL.
Group buying discounts available to members from companies that work closely with our association.
Your name and practice will be listed on the FACD website membership directory, giving you increased visibility to patients searching for a cosmetic dentist in their area.

Name:

PrefixFirst NameLast Name

Designation (Example: DMD, DDS):

If not applicable, please put N/A

Email:

example@example.com

Please select your membership type:

Office/School Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Accredited University or College:

Office Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Practice Name

Practice Website

Practice Logo (for website directory)

Instagram Handle (Optional):

We would love to connect with you on Instagram! Share your Instagram handle below so the Florida Academy of Cosmetic Dentistry (FACD) can follow you and engage with your content.

Headshot (Optional):

We love highlighting our FACD members! Upload a professional headshot for the opportunity to be featured in a Member Spotlight in our member e-newsletters or on our social media channels. We will reach out to you beforehand to coordinate the spotlight.

Home Address (For mailing purposes)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Mailing Address

Payment Type:

Please make checks payable to:

Florida Academy of Cosmetic Dentistry | PO Box 4373 | Brandon, FL | 33509

Check Amount:

Check Number:

Card Payment:

Membership Dues (Doctor/Lab Technician)

$500.00

Membership Dues (Faculty)

Teaching staff of an accredited university or college.

$200.00

Membership Dues (Recent/Post Graduate)

1-2 years out of school

$100.00

Membership Dues (Student)

Current student of an accredited university of school.

$50.00

Speaker Fund Donation

This is to support speakers for FACD related events.

$100.00 Quantity

Total

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

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FACD Membership Renewal

Card Payment:*

Card Payment: