The American Academy of Fixed Prosthodontics

Membership Application

 Step 1: Personal Information

   
Home Information  
   
Primary Office Information Please provide your practice address if you want to be included in the member directory
   
   

Step 2: Educational Information

Degrees earned (check all that apply)  
   
   
   
   
   
   
   
   
   
   

   

:
Certified by the American Board of Prosthodontics?      
Is the candidate certified by another ADA recognized specialty?      
   

Step 3: Professional Information

    
Professional Activity (check all that apply with percentages)
   
Areas of Interest (check all that apply and place appropriate percentage of your total practice.)
 
     
 
   
   
   
   
   
    
Confidential Information:  
 Has the nominee ever been censured by any component of organized dentistry?       
If the answer to the above is yes, explain the circumstances in a separate enclosure. The information contained therein will be available only to the Credentials Committee for their use during deliberations and will be held in the strictest confidence.
  (if any)  

Sponsor Information:

 

 

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