Online Membership Application
NOTE: This form is for new members only. DO NOT use the form below to renew your
membership. To renew your membership please register
with the AADSM web site
as a member to access your account and complete
your renewal. Thank you.
* Required fields
Date Of Birth:
Listed in the online Membership Directory and annual online
Membership Directory; if no professional address is provided, only your name will
be listed in the directory. Mailing Address
This is a:
You must provide at least one phone number. Phone numbers
from the United States must be in the format (xxx) xxx-xxxx.
To become a member of the AADSM, please provide a valid scan of your medical or dental license. License submissions must be in a jpg, jpeg, doc, docx, pdf, gif, or tif file format.