Retired Member/Fellow Application
Thank you for your interest in applying for Retired Member status. After reaching sixty-five (65) years of age, a voting member for ten (10) years, who is no longer working as a Registered Dental Hygienist in any setting or related professional area of employment due to age or disability, may apply for Retired Member/Fellow status to the Governing Council. Retired membership retains the rights and voting privileges of a full voting member.
Requirement:
Date:
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Today's Date
Name of Candidate:
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First Name
Last Name
Phone Number:
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Area Code
Phone Number
Email Address:
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Date of Initial Membership to AADH
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Month
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Day
Year
Date
Upload sworn affidavit
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Upload passport or birth certificate
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of
Upload the total number of hours employed in any setting including the employer information.
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of
Upload minimum of eight (8) hours of continuing education.
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of
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