Membership Status Change Request

Note on COVID-19

Due to the COVID-19 global pandemic response, we are experiencing a higher than normal amount of dues waiver requests. Before your membership benefits expiring, you may also sign up for the AGD installment plan and separate membership dues into three monthly installments to provide additional flexibility. If you are searching for flexibility in your membership renewal, we encourage you to consider this option before requesting a full dues waiver for the 2020 calendar year.

> Login to the Membership Renewal Page

> Click “RENEW NOW"

> When prompted to pay full amount or installments, select “AGD Headquarters Dues - I want to pay in three monthly installments”

> Submit your first installment payment, and you’re signed up!

Learn more about how the AGD is supporting its members during the pandemic at https://www.agd.org/coronavirus

The Academy of General Dentistry (AGD) recognizes that members’ circumstances change throughout their careers. To assist members through these transitions, the AGD offers various membership status options to current members in good standing. In the event your situation does not fall under any of these categories, you may submit a special request for consideration by the Membership Council to membership@agd.org.

If you wish to apply for a status change, please complete this application and provide a one-page letter explaining your situation as supporting documentation. This information will be provided to the Membership Council for their review.


Please select the option that best represents your circumstances.
Leave of Absence
Hardship
Total Disability
Retired Membership
I hereby attest that I am eligible for the above dues waiver request, and that my license to practice dentistry has not been revoked or suspended.
This field is required Please upload relevant documents.
Select a file to upload.