Membership

Member Application

Your Name Contact Info Your Background Education Member Category Payment Info

Welcome!

We are excited that you have decided to join the AGD, the only organization advancing the value and excellence of general dentistry.

Please start your application process in the online application form below, or you can also General Membership Application PDF and send it with your payment to:

Mail:
Academy of General Dentistry
211 East Chicago Avenue, Suite 900
Chicago, IL 60611-1999

Fax:
312.335.3443

Use this form if you have not previously been a member of the AGD. Current members wishing to renew should use the AGD Online Membership Renewal form.

STEP 1: We'd like to get to know you

Full Name:
Title First Name    M.I.   Last Name    Degree

Informal Name:

Spouse's Name:

Is your spouse a member of the AGD?
Yes No
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