Membership

  • Personal Information
  • Education/Practice Profile
  • Membership Type
  • Confirmation and Payment
  • Payment Confirmation

Welcome and thank you for your interest in the Academy of General Dentistry!

Current AGD Members: If you would like to renew your AGD membership, please visit the online renewal application.

If you have questions while completing the application, please contact the AGD Membership Services Center at 888.243.3368, 312.440.4300, or membership@agd.org.

STEP 1: Personal Information

Title First Name Required field   M.I.   Last Name Required field   Designation

Preferred Name (if different than above)

Primary E-mail Address Required field

Preferred Billing Address Required field Business Address Home Address

The location of your business or residency will determine your local constituency. To be included in the Find an AGD Dentist online directory, your business address is required.

Preferred method of contact     

Business Address

Address
   
City
State/Province
Zip/Postal Code
Country
Phone
Fax
Web site http://

Home Address

Address  
   
City  
State/Province  
Zip/Postal Code  
Country  
Phone  

Check here if you’d like to receive special offers and promotions directly from the AGD Member Savings & Offers providers and Corporate Sponsors.


AGD Privacy Information

Date of Birth Required field
Are you a graduate of (or resident in) an accredited U.S. or Canadian dental school or program, or equivalent foreign educational program? Required field
Yes No
Do you hold a valid and current dentist license to practice in your country of residence?
Yes No
Promotional Code
(if applicable)
 
Gender  
Male Female
Ethnicity  
American Indian Asian
African-American Hispanic
Caucasian Other
Are you currently a member of any other dental organization?  
ADA
ADEA
CDA
ASDA
Other
AGD Mentoring Program   I want to find a mentor
I want to become a mentor

Refer a Colleague Information
Were you referred to AGD by a current member? Please provide their information here.

Name  
State or Province  
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