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Affiliate Membership Application

Affiliate Membership in the American Dental Association is available to dentists who live outside the U.S. AND practice outside the U.S. After completing the application below, the ADA will be in touch with you within two weeks. Membership is for the calendar year. If you do not meet both criteria for Affiliate Membership, you may be eligible for another membership category in the ADA. Thank you for your interest in joining the ADA as a member.

* indicates required field. Please enter your ADA number and click the "search" button. If your information is in the ADA system, your data will appear below. Please update your record if needed. If no information appears, please type in the information.



Personal Information
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Education Information

Please attach a copy of your dental school diploma (English translation required). If you cannot attach a copy, fax a copy to the American Dental Association at 312-440-2898 or mail it to: American Dental Assn, Attn: Affiliate Membership, 211 E Chicago Ave, Chicago, IL 60611 United States.

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Address Information
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Dues Information

You are currently requesting Affiliate (Non-U.S.) Membership in the ADA .

 
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