Member Application Form
    Fill out each tab below, clicking [Submit Information] when completed, then click [Submit Application].

Member Overview / Summary
Contact Info Email Address needs to be updated:
Contact Info Mailing Address needs to be updated:
Contact Name:
Membership ID:
Contact Email Address:
Affiliation:
Membership Classification:
Journal Subscription:
Link to Journal tab for instructions on ordering hard-copy subscription.
Current Amount Due: $0        
Contact information made available on ADM website:
Join the ADM: ADM Membership Fees – select one of the following Fees if you are applying for ADM membership.
After completing a page, click Submit Information button to go to next page.
  • Student (Annual Dues: $40)
    Students are individuals with an interest in dental materials research and currently enrolled in an education program. Students must provide a signed confirmation letter of student status from either a sponsoring member or their learning institute, and complete the Education tab with expected graduation date.
  • First Year New Member (Annual Dues: $74)
    (first year cost)- Active membership is $149/year and begins after new member status, ending this calendar year (December). Select this option if this is your first time applying for ADM membership.
  • Regular Member (Annual Dues: $149)
    Active membership is $149/year and begins after new member status, ending this calendar year (December). Select this option if you have previously been a member of the ADM or you are an inactive member reactivating your membership.
  • Corporate (Annual Dues: $2000)
    Corporate Membership shall be recognized as a special membership status for business corporations. Corporate members will receive a complimentary subscription to Dental Materials (the journal) for the membership year. Corporate member names and corporate logos will appear in each issue of Dental Materials (the journal) throughout the membership year in acknowledgment of their member status. Corporate membership requires payment of annual dues.
All memberships include an On-Line internet subscription to the Dental Materials journal. Hardcopy subscriptions are optional and can be ordered on the Payment tab.

For check payment, download this pdf (click here) to apply via email, fax or mail to:
Deanna Hilton
21 Grouse Terrace
Lake Oswego, OR 97035
Phone: +1 (503) 636-0861
Fax: +1 (503) 675-2738
Email: admin@academydentalmaterials.org

Please note that all transactions are non-refundable. Delivery of accessible membership privileges is provided electronically upon successful receipt of payment. Membership dues are on a calendar year basis for all membership categories. Annual membership will only be activated upon receipt of payment.
Member / Contact Information
First Name/Given Name/Forename:
Last/Surname/Family Name:
Country:
Address 1:
Address 2:
City:
State/Province/Region:
Zip/Postal Code:
Telephone Number (include country code):
Email Address:

Check box to include your information on public ADM website (Find a member)   
Login Information
How did you hear about the ADM?
Username:
Password:
Confirm Password:
Journal of Dental Materials – New applicants and members can only order the hard copy journal subscription when either joining or renewing their annual membership.

On-Line access to DENTAL MATERIALS is accessible to current members by clicking the Journal ICON link below after payment. A hard copy subscription is also available to all Membership types (except students) by choosing the Journal option on Payment Page tab. Emeritus members will have online access and a hard copy subscription if they elect to purchase the hard copy.

Hard copy - $26
You will elect to pay for the journal on the "Payment" tab.
Complete the Mailing Address fields below for hard copy delivery of Dental Materials. Subscription is for 1 calendar year. All journals will be sent for the current calendar year. Subscription is included with future ADM membership payment, unless member “unchecks” Hard copy box on the payment page.

Mailing Address
Same as Contact Information?
Country:
Address 1:
Address 2:
City:
State/Province/Region:
Zip/Postal Code:
Hard Copy Journal Request History
to change your mailing address on an existing order below, click 'Edit Address' which will load the address boxes above. Type information in Mailing Address boxes for your new mailing address. Then click 'Save Updated Journal Address'
Education Information
Title(s):
Other:
Licensed?
Certified?
Professor?
Specialist Registration:
Undergraduate School Attended:
Undergraduate Degree Completed:
Graduate School(s): Include graduate schools attended, degress and dates completed:
Are you currently a Student in an accredited program?
Program Director/Advisor:
Program Director/Advisor Phone Number or Email Address:
If you are a Student, what is your projected Graduation Date?
Affiliation Information (type N/A for any fields that are not applicable)
University / Institution / Affiliation / Private Practice:
Department:
Position / Title:
Personal / Private Practice Website URL:
Other Information (Optional)
Date of Birth: / /
Other Organizational Memberships:
Publications: Publications: List authors, article title, publication name and published date.
Example: Fitzpatrick BJ, Brockhurst P, Gullotta E. Determination of gold alloy loss during the production of cast dental restorations. USAn Dent Journal; Accepted for publication January 1998
Member Photos

(Note 1): Photo file extension cannot contain UPPER CASE characters (e.g. on your computer, richt click & rename yourfile.JPG to yourfile.jpg
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Member Registration Payments

           


Credit Card Information
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(includes any late res_fees and/or processing fees)
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Breakdown of Fees
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Payment History
Annual dues payment history will commence in the calendar year 2013

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Conference Payment History
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Member Classification Change
  • If you are a Student and request change to Regular Member, submit “Request Change” for Regular Member
  • If you are a Regular Member and request a change to Fellow, click the link for FELLOW for instructions for application and submit “Request Change” for Fellow Member.
  • • If you are a Regular Member or Fellow Member and request a change to Emeritus, click the link for EMERITUS for instructions for application, and submit “Request Change” for Emeritus.
The Membership Committee will review your request for consideration. Post any comments in the comment box below that will assist your administration office with your request for change of membership classification.

Comments:
 Classification
Student (Annual Dues: $40 , Includes: on-line journal)
Students are individuals with an interest in dental materials research and currently enrolled in an education program. Students must provide a signed confirmation letter of student status from either a sponsoring member or their learning institute, and complete the Education tab with expected graduation date.
Regular Member (Annual Dues: $149 , Includes: on-line journal)
Active membership is $149/year and begins after new member status, ending this calendar year (December). Select this option if you have previously been a member of the ADM or you are an inactive member reactivating your membership.
Fellow (Annual Dues: $149 , Includes: on-line journal)
Fellowships are approved by the Credentials Committee according to the following guidelines:
  1. Achievement of advanced degrees: at least a master's degree and preferably a Ph.D., Odont Dr., or equivalent degree;
  2. Evidence of contribution: publication of at least ten (10), peer-reviewed, scientific articles in refereed journals, of which the candidate should be first author on one-half of the articles; and
  3. Longevity of commitment to the field: at least five (5) years of leadership through research, training, service and/or education beyond formal education.
  4. Normally at least Five (5) years of membership in the Academy of Dental Materials
Candidates for Fellowship should submit a curriculum vitae and letters of recommendation from a minimum of two Fellows of the Academy.
Corporate (Annual Dues: $2000 , Includes: on-line journal)
Corporate Membership shall be recognized as a special membership status for business corporations. Corporate members will receive a complimentary subscription to Dental Materials (the journal) for the membership year. Corporate member names and corporate logos will appear in each issue of Dental Materials (the journal) throughout the membership year in acknowledgment of their member status. Corporate membership requires payment of annual dues.
Emeritus (Annual Dues: $0, without any journal subscription )
Emeritus Members are those individuals who have contributed to the field of dental materials and have retired from their professional position. They must have been Active Members or Fellows prior to achieving Emeritus status. An individual must apply in writing to the Secretary or President for Emeritus status. The Board of Directors will vote on awarding the Emeritus membership. An Emeritus Member will pay no dues, but would be assessed a member's subscription rate for the journal should he/she decide to continue the subscription. All other rights and privileges of Active Membership would be maintained.
Member Resources...
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ADM - ACADEMY OF DENTAL MATERIALS        21 Grouse Terrace, Lake Oswego, OR 97035-1013, USA        P: 07 3223 5000   (+1-503-675-2738)   E: admin@academydentalmaterials.org