Life Membership

Consider Life Membership

This membership is for those who desire to be a part of the NDA for remainder of their life. To declare this membership status, applicants must complete the NDA Life Membership Application (below) and fulfill the following requirements.

Requirements:

NDA Member for 30 years. (Member must show proof)
Active member in good standing.
Minimum age of 65.
Member in good standing in component/constituent society.
Completed the Life Member Application (below)
Two letters of recommendation.
Submitted curriculum vitae or resume
Photograph (8”x10” color)
Answer: What does the NDA mean to you?
An active member may pay back dues for a maximum of 5 years to correct any gaps in the required 30 consecutive years

Please complete the form below.

Life Membership Application

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Office Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

Home Phone

Mobile

Fax

Dental School(Required)

Year of Graduation(Required)

Specialty(Required)

Date Joined NDA(Required)

Name of Component / Constituent Society(Required)

* Please send a letter stating why the NDA should consider this individual for life membership.*

One reference letter must be sent by the component / constituent society

Reference 1 (NDA Member)(Required)

Prefix First Last Suffix

Reference 2 (NDA Member)(Required)

Prefix First Last Suffix

* What does the NDA mean to you?*

Answer:(Required)

Upload Supporting Documents

Max. file size: 100 MB.

1) Two letters of recommendation. 2) Submitted curriculum vitae or resume 3) Photograph (8”x10” color)

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