ADEA Partner Organization Membership Application

To qualify as a Partner Organization Member, an entity shall be a non-profit organization or professionally affiliated group from all countries who work with health care communities and share ADEA values, including consortia of international schools, non-profit academic dental associations/consortia, or other groups. Partner membership offers public, private and national/regional organizations a connection to oral health education.

Partner Organization Dues:

Tier 1 (10 employees or less)	$1,500
Tier 2 (11-50 employees)	$2,000
Tier 3 (more than 50 employees)	$3,000

All ADEA Partner Organization Member applications are approved by the ADEA Board of Directors.

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

Month of Approval	Description	Tier 1	Tier 2	Tier 3
January	Full-year Dues	$1,500	$2,000	$3,000
March	9 Month Dues	$1,125	$1,500	$2,250
June	6 Month Dues	$750	$1,000	$1,500
September	3 Months + Full Year	$1,875	$2,500	$4,500

* 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

Organization Information

Organization Name:

Street Address:

Street Address Line 2:

City:

State:

Province:

Zip Code:

Country:

Work Number:

Format: (000) 000-0000.

Fax Number:

Format: (000) 000-0000.

Organization Website URL:

Which category best represents your organization?

Which 'Other' category best represents your organization?

Enter 'n/a' if not applicable

Which tier of membership are you interested in?

Organization Description:

Description is limited to 250 words.0/250

Why do you want to become a part of the ADEA academic dental community?

How does your mission support and/or enhance the dental education community?

This one-time application is subject to approval by the ADEA Board of Directors, which considers new applications when it meets in January, March, June and September.

The organization name will be listed on the ADEA Partner Organization Member roster exactly as shown above. The official contact will be the official organization contact identified above.