Active

Active Membership is available to licensed dentists, researchers, and dental laboratory technicians who are actively engaged in the field of prosthetic dentistry and who support the Academy’s mission and abide by its Bylaws and policies. Active Members enjoy full voting privileges and may serve as directors, officers, and committee members or chairs. Annual dues apply as determined by the Board of Directors.

Applicant Information

First Name

Last Name

Professional Title / Degree(s)

Institution / Practice

Primary Specialty

Address

City

State/Province

Zip / Postal Code

Country

E-mail

Phone

Professional Credentials

State/Country of Licensure

Current Position

Brief Description of Professional Involvement in Prosthetic Dentistry

Supporting Documentation

Current CV

Proof of Professional Licensure

By submitting this application, I support the Purpose of the Academy, agree to follow all Bylaws and policies, and certify all information is accurate.

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