AADT Membership Application

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American Academy of Dental Therapy

c/o ANTHC Alaska Dental Health Aide Ed. Program

4200 Lake Otis Parkway, Ste. 204

Anchorage, AK 99508

907-729-5600

Fax 907-729-5610

 

AADT Membership Application

 

Click here to download a PDF version of the application.

Personal Information

Name:

MaleFemale

Date Of Birth:

Biographical Information

Employment Description

Payment

Enclosed is my check for membership dues in the amount of $100.00Annual Fee for non-voting member is $50.00 per membership year

Applicant Signature

I hereby apply for Direct membership in the Alaska Association of Dental Health Aide Therapists and resolve to abide in the Bylaws and the Principals of Ethics and Code of Professional Conduct if accepted into membership.