DSIG Application

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Predoctoral students enrolled in an accredited U.S. or Canadian dental school may complete and submit the application below to join the AAP's Dental Student Interest Group and get access to extensive resources on the specialty of periodontics. A credit-card payment of $57 for one year in DSIG is required for acceptance of your application.

Members Only Content:

Not Member Only

PERSONAL INFORMATION

First Name: *

Middle Name or Initial:

Last Name: *

Suffix:

Gender: *

Male

Female

Date of Birth (mm/dd/yyyy): *

CONTACT INFORMATION

Street Address: *

City: *

State / Province: *

Zip/Postal Code: *

Phone Number (###-###-####): *

Type of Phone: *

Cell Phone

Home Phone

Other

Email Address: *

Confirm Email: *

Required for payment of DSIG annual fee

EDUCATION

Dental School: *

Predoctoral Director: *

Expected Graduation Date (mm/yyyy): *

ASDA Membership Number: *

What DSIG resources do you feel will be most helpful to you, and why?

Your response will help us develop more resources for students and promote the value of DSIG participation.

PAYMENT PROCESS

After you submit your application, a link to pay your $57 DSIG annual fee will be emailed to you within one business day. Please click the link to go to a secure site for entering your credit-card information. Soon after we receive your payment, you will receive a confirmation email with instructions for accessing AAP resources.

Click to Confirm: *

I understand the above payment process that is required for activation of my DSIG membership.