Texas Academy of General Dentistry
Application for Membership

 

Name:
Mailing Address:
City, State, Zip:
Phone: Fax:
E-mail:
Date of birth (mm/dd/yy):
/ /

Dental School:
Year of Graduation: License #:
New Dentist?
* If you graduated less than five years ago, your dues are less! See special dues rates below.
Professional Interest - Check any areas of interest
that you'd like to know more about or participate in:
/volunteering
Other
 
Practice Status - check all that apply:
Specialist (specify)
   
Sponsor Name:
AGD # (if known):
2010 Academy Dues - State & National
Starting July 1 – October 1, dues are half price. Only full dues are eligible. New dentists special dues rate remains the same. CE tracking for members receiving half price dues begins July 1.

-Or-

 $252
New Dentist - Special Dues Rates - State & National
*New Dentist Dues dues will remain the same and are not eligible for half price dues.

-Or-

 $
Student Dues

-Plus-

 $16
  Local Component Dues
Dues vary by component area. See table. Students do not pay local dues.		 $

Total - Pay this amount: $0

New Dentist Special Dues Rates

• 2009  or 2010 Graduate or Current Resident $131
• 2008 Graduate $227
• 2007 Graduate $332
• 2006 Graduate $435

Local Component Dues - 2010

Brazos Valley AGD $25
Central Texas AGD $35
Dallas AGD $45
East Texas AGD $20
El Paso AGD $10
Fort Worth AGD $40
Heart of Texas AGD $15
Lubbock AGD $35
Panhandle AGD $0
Rio Grande Valley AGD $40
River District AGD $15
San Antonio AGD $50
Southeast Texas AGD $10
   
Houston AGD $50
2009 Graduate $25
2008 Graduate $35
2007 Graduate $45
Click for zip codes