ADEA Corporate Membership Application

Corporate Membership Application

Corporate Membership includes 10 individual memberships for Corporate Member staff.

To qualify as a Corporate Member, an entity shall be a company dealing with products and/or services beneficial to dental education and/or dentistry, and it must not cite Corporate Membership for commercial purposes (e.g., it must not imply ADEA endorsement of products and services).

Corporate Membership Dues: $3,750*

All ADEA corporate member applications are approved by the Board of Directors.

Based on that approval cycle, corporate member dues are prorated as noted below:

January Approval	Full-year Dues	$3,750
March Approval	9 Month Dues	$2,812
June Approval	6 Month Dues	$1,875
September Approval	3 Months + Calendar Year Dues	$4,687.50

* Pre-Payment is not required. ADEA will send an invoice after approval.

IMPORTANT: If you are applying for an individual membership or if your organization is an existing ADEA member go to the Individual Registration Form.

Name of Official Contact:*

PrefixFirst NameLast NameSuffix
Official Contact Title:*
Official Contact Email:*

Confirmation Emailexample@example.com
Company Information
Company Name:*
Street Address:*
Street Address Line 2:
City:
State:
Province
Zip Code*
Country
Work Number:*
Fax Number:
Company Website URL:
Which category best represents your organization?*
Which 'Other' category best represents your organization?*
Company Description:*

Description is limited to 250 words.0/250
Why do you want to become a part of the ADEA academic dental community? (replaced on 4/18/17)
How does your product or service support and/or enhance the dental education community? (replaced on 5/31/17)
Why do you want to become a part of the ADEA academic dental community and how does your product or service support and/or enhance the dental education community?*
Are you currently working with dental education programs (i.e. Dental Hygiene, Allied Programs)?*

YesNo
Please list the dental education programs with which you are currently working?*
Do you belong to other oral health & dentistry-related associations / organizations?*

YesNo
Please list the oral health & dentistry-related associations / organizations to which you belong.
This one-time application is subject to approval by ADEA's Board of Directors, which considers new applications when it meets in January, March, June and September.

The company name will be listed on the ADEA Corporate Member roster exactly as shown above and the official contact will be the company's representative on ADEA's Corporate Council.
Should be Empty: