AAP Active Membership Application

Complete and submit this form to apply for membership.

Annual dues are for the calendar year Jan.1 to Dec. 31. Applications received on or after Oct. 31 are processed with a join date of Jan. 1 the following year.

Active Membership dues for 2018 are $990 with a $200 application fee.

Benefits and Eligibility Requirements for Member Categories

Note: Application fee is waived for past members.

Members Only Content:

Not Member Only

MAILING ADDRESS

Send AAP Mailings to: *

My Home

My Office

Street Address: *

Street Address 3

Street Address 2

City: *

State or Province:

Zip/Postal Code:

Country: *

OTHER CONTACT INFORMATION

Primary Phone Number: *

This is my (check one)

Office #

Home #

Cell #

Fax:

Email Address: *

Confirm Email Address: *

Required for payment of membership dues and application fee.

Website:

DENTAL SCHOOL & LICENSE

Dental School: *

Degree Earned: *

Year of Graduation: *

Place of Licensure: *

Dental License Number *

POSTDOCTORAL TRAINING

Perio Training Institution: *

Perio Program Director: *

Date of Periodontal Certification: *

Other Specialty Training (if any):

Institution for Other Training:

Date of Other Certification:

PROFESSIONAL ORGANIZATION & CERTIFICATION

Membership in the American Dental Association is required for U.S. applicants.

Organization Name: *

Membership Number: *

APPLICATION VERIFICATION

Click to Verify: *

I certify that the foregoing information is true and correct to the best of my knowledge. I believe I am eligible for membership in the category requested. If I am elected to membership in the American Academy of Periodontology, I agree to uphold the principles and the objectives of the Academy and abide by its bylaws. I agree further to advise the Academy of any changes in status that would amend or alter the information provided in the application. I understand that a portion of the membership fee is payment for a Journal of Periodontology subscription (U.S. $273).

ADDITIONAL APPLICATION DETAILS

Promotional Code (if applicable):

Referred to AAP by:

What AAP member benefit do you look forward to the most, and why?

Your response will help us to develop member benefits that meet your needs.

Permission:

Click here if you're willing to have your answer to the preceding question used in future materials on the value of AAP membership.

PAYMENT PROCESS

After you submit your application, a link to pay your membership dues and application fee will be sent to you within three business days at the above email address. Please click the link to go to a secure site for entering your credit-card information. Once we receive your payment, your membership will be activated.

Click to Confirm: *

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

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AAP Active Membership Application