Online Membership Application
This form is for NEW MEMBERS ONLY.
DO NOT use the form to the right to renew your membership.
If you have ever had an AADSM membership previously, please log in to your account where you will be prompted to renew.
If you do not know your account information or are unsure if you have a preexisting account, please call (630) 737-9755, or email AADSMmembership@aadsm.org
As a reminder, memberships run on a calendar year basis (January 1 – December 31).
Highlighted sections are required.
* 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.