Professional Application

How did you learn about ADAA?
 If other, please specify:

Contact Information

First Name
Middle
Last Name
Suffix
Title
Email
Company Name
Mailing Address *Be sure to include Apt or Unit # in the address field, if applicable.
Address
City
State
Zip Code
Please enter at least ONE phone number.
Cell Phone
Home Phone
Business Phone
Certification is NOT required to join ADAA. List credentials below in order of importance. Only the first 20-25 characters, including your name, will appear on your membership card.
Credentials
Please check the applicable fields that represent your duties as a Dental Assistant. Please use CTRL (PC) or COMMAND (MAC) to multi-select.
Duties
 If other, please specify:

Membership

National Dues AND State dues are required to join the ADAA. Both are required to renew your membership in the ADAA, also.
All Memberships are individual-based and are for a full year (365 days) from the time the dues payment is processed. Membership, professional liability insurance and accidental death insurance become effective following receipt and processing of application.
By Joining the ADAA, you also become a member of at least one state organization and one local organization if one exists. ADAA will submit your information to the appropriate state and/or local associations. Local membership will be in the same state as state membership.

Professional membership dues: National dues = $125.00 + State dues (calculated from the States you enter below)

National Dues
Professional Membership Category dues
State Dues
Please choose the Primary State Association and any additional State Associations you wish to join below. The Primary State Association should be the same state you live in. You will be charged state dues for every state you select.
AK - $15
AL - $10
AZ - $15
AR - $10
CA - $40
CO - $15
CT - $18
DE - $6
DC - $12
FL - $25
GA - $12
GU - $0
HI - $12
ID - $12
IL - $23
IN - $35
IA - $25
KS - $20
KY - $10
LA - $12
ME - $10
MD - $20
MA - $20
MI - $40
MN - $30
MS - $15
MO - $10
MT - $10
NE - $25
NV - $20
NH - $10
NJ - $20
NM - $10
NY - $20
NC - $15
ND - $15
OH - $20
OK - $15
OR - $15
PA - $20
PR - $0
RI - $18
SC - $13
SD - $20
TN - $20
TX - $25
UT - $15
VI - $0
VT - $10
VA - $24
WA - $15
WV - $15
WI - $24
WY - $10
Primary State Chapter
Choose your Primary State Chapter below. The State Chapter should be the same state you live in. Please choose ONE from the drop down list below.
State Chapter Association
Local Association
Choose your Primary Local Chapter from the list below. The list is in order by state name. Locals are listed under each state. The Local Chapter (if there is one) should be in the same state as your primary state. Please choose ONE from the drop down list below. Note: if there isn't a local chapter in your state, choose the state chapter only option. Ex: for Maryland, choose, "Maryland State Chapter Only".
Local Chapter 1

Membership Plaques

Membership Plaques are available for purchase. They come with a current year decal and are not engraved. Plaques are mailed out twice a month via USPS and can take up to six weeks for delivery.
Membership Plaque $40 (optional)

The Professional Dental Assistants Education Foundation (PDAEF)

The Professional Dental Assistants Education Foundation (PDAEF) is a 501(c)(3) foundation affiliated with the American Dental Assistants Association (ADAA). The Foundation received its IRS determination letter approving its 501(c)(3) status on May 31, 2016. Contributions or donations made to PDAEF, a 501(c)(3) organization, are tax deductible to the extent that the law allows. CLICK HERE for More Information!

PDAEF

Enter the amount of donation you would like to make to the Professional Dental Assistants Education Foundation (optional):
PDAEF Donation Amount$

NO PORTION OF ADAA FEES ARE REFUNDABLE OR TRANSFERABLE *Membership includes a subscription to The Dental Assistant, $50,000 professional dental assisting liability insurance policy, $2000 accidental death/dismemberment insurance policy and access to the ADAA E-Learning courses through BizLibrary. Access will be given the morning after you join or renew, after 8:00am Central. *Membership, professional liability insurance and accidental death insurance become effective following receipt and processing of application *ALL MEMBERSHIP PAYMENT OPTIONS ARE FOR ONE FULL YEAR. BY SUBMITTING THIS APPLICATION YOU AGREE TO A FULL YEAR OF MEMBERSHIP WHICH CANNOT BE CANCELLED OR REFUNDED. "* Monthly, Quarterly, and Semi Annual payment options are not available at this time.
   - denotes required fields