ACADEMY OF
DENTAL MATERIALS

Student

Students - with no PhD

Students and Resident 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.

NOTE: Individuals who already hold a PhD degree are not eligible for Student Membership. Please apply as a Regular Member or First Year New Member

Membership Dues: $40.00

Honorific

First Name

Last Name

Date of Birth

Other Organizational Memberships

Contact Information

Country

Address

City

State / Province

Zip / Postal Code

Telephone Number (include country code)

Education Information

Designations
BSc
BDS
BDSc
MS
MDS
MDSc
MSc
D Clin Dent
DMD
PhD
DDS
DDSc

Other Designations

Licensed?
Y N

Certified?
Y N

Professor?
Y N

Specialist Registration

Other Specialty

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?
Y N

Program Director/Advisor

Program Director/Advisor Phone Number or Email Address

If you are a Student, what is your projected Graduation Date?

I do not have a PhD title
Y N

I am enrolled in a Masters, PhD or dental degree program
Y N

Affiliation Information

University / Institution / Affiliation / Private Practice

Department

Position / Title

Personal / Private Practice Website URL

Other Information

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

Privacy Information

How did you hear about the ADM?
A Member Referral
ADM Annual Conference
ADM Web Site
Colleague
Dental Materials journal
Journal Advertising (other than Dental Materials journal)
Other:

Do you consent to receive event and marketing communications from us?
Y N

Show in member directories?
visible hidden

Office use only: