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Dental Education

Membership period is for the calendar year January 1 through December 31, 2008 Click Here To Download The 2008 Membership/Registration Application
*PERSONAL INFORMATION: = Required Field**

Check if:	New member Renewal
Year Joined:

*First Name:
Middle Name:
*Last Name:
Hyphen Name:
Suffix:
Date of Birth:	/ /
	* Male Female
	* DDS DMD
Additional Degree(s) / Certification(s):
Preferred Mailing Address:	Home Office
*Street Address:
*City:
*State:
*Zip Code:

*Office Telephone:
Fax:
Home Telephone:
Email:

*Dental School:
Year Degree Conferred:
Name of Local Society:
Name of State Society:

(Check all that apply)
Trustee Delegate Executive Committee Past President Life Member First Time Attending

PROFESSIONAL ACTIVITY: *

General Practice Orthodontics Endodontics Pediatric Dentistry Oral Pathology Periodontics Oral Surgery Prosthodontics Public Health Other:

2008 MEMBERSHIP DUES:

Active Member		$395.00
Faculty Member (copy of faculty ID is required, please mail or fax )		$270.00
Active Military Member (copy of military ID is required, please mail or fax )		$270.00
Affiliate/International Member (Dentist practicing outside the U.S. and U.S. Territories)		$270.00
Associate Member (Non-Dentist)		$270.00
Retired Member (verification is required)		$270.00
Graduates and Residents (must mail in registration to NDA headquarters)
Click Here for "NEW" Dues Info	Click Here for 2008 Application
Life Member(approval must be granted)		no dues

CONVENTION REGISTRATION INCLUDES :

Admission to All Scientific Sessions Access to All Technical Exhibits One (1) Ticket to President's Gala One (1) Ticket to NDA Grand Finale
REGISTRATION FEES: NO CHECKS DURING ON-SITE REGISTRATION & NO REFUNDS AFTER JUNE 1ST, 2008

	Early Bird Registration thru May 31st	Late Registration as of June 1st
NDA Member	$595.00	$755.00
Non-NDA Member	$1050.00	$1300.00

SPECIAL EVENT TICKETS:

Qty.	Early Bird Registration thru May 31st	Late Registration as of June 1st
President's Gala	$90.00 ea.	$100.00 ea
Civil Rights Luncheon	$65.00 ea.	$75.00 ea
Women Dentists Luncheon	$65.00 ea.	$75.00 ea
Scholarship Golf Classic	$150.00 ea.	$170.00 ea
NDA Grand Finale	$55.00 ea.	$60.00 ea
CPR Certification	$55.00 ea.	$60.00 ea

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National Dental Association
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Phone: 202 588 1697 Fax: 202 588 1244
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