Initial Membership Application
Thank you for your interest in becoming a member of the American Academy of Dental Hygiene Inc.! We look forward to reviewing your application. Submission of application is not a guarantee of membership. All applications are screened by the Membership Committee and then forwarded to the Governing Council for final approval. You will receive notification of final membership status. This process may take up to 4-8 weeks. If you have questions regarding the application process email Danni Gomes at admin@aadh.org.
Application Fee:
$35.00
Membership Dues:
$175.00
Submission requirements checklist:
Date of Application:
Today's Date
Name:
First Name
Last Name
Credentials:
Credentials
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SMS Number:
-
Area Code
Phone Number
Email Address:
Please avoid using an email address ending in .edu so our emails won't get blocked
Birthdate: (optional)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you hear about AADH?
Friend
Website
Colleague
Convention
Social media
Other
Who should we thank for referring you?
Please provide 3-5 lines describing your career philosophy and/or experiences.
*
Upload headshot (optional) *used to recognize you on our website and/or social profiles.
Enter Instagram username here (if applicable) so we can tag you on post
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Education:
*
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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,)
Curriculum Vitae/Resume:
*
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Professional Career Experience:
Please provide the following information for each applicable experience:
*
Continuing Education Course Listing:
Continuing education is defined as non-degree credit bearing courses for adults, regardless of previous education, offered by a university, institute or provider which is recognized as adjunctive or belonging to the practice of dental hygiene. Minimum of twenty-five (25) 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 CE Course Spreadsheet below:
Please make a copy of this spreadsheet, enter your information, save it as a pdf and upload it below.
Upload the CE Course Spreadsheet :
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Nonrefundable Membership Application & Dues Payment:
Please submit the appropriate payments below. Please note that your application will not be reviewed until all payments are submitted.
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AADH Initial Membership Application Fee & Membership Dues
$210.00
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210.00
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