New Member Candidate

Prospective Member Instructions & Application

New Member Candidates must be sponsored by at least two Academy members who are well acquainted with the candidate and will serve as sponsors. Completed application must be received by the Academy Secretary by January 1 prior to the Annual Scientific Session at which the candidate's nomination will be considered.

The candidate's application will be acted on by the:

• Credentials Committee
• Board of Directors
• General membership of the Academy

The new member will be recognized before the general membership during the Friday Luncheon at the Annual Scientific Session.

Step 1: The new member candidate must:

• Complete and sign the Membership Application form (click on the red APPLY NOW button at the bottom of this page)
• Forward the nomination form link, to their Academy sponsors:

https://www.fixedprosthodontics.org/cgi/ex.cgi/page/AAFP/memberinfo/prospective_members/categories/membership_nomination

• Complete payment of membership application fee (includes the registration fee for the Annual Scientific Session at which your nomination is being considered but meeting registration is still required)
• Appear for an interview with the Credentials Committee, scheduled on the Thursday immediately preceding the Annual Scientific Session

Step 2: The Academy member sponsors will:

• Affirm that the candidate is deserving of nomination
• Sign and return the application to the Academy Secretary by January 1 prior to the meeting at which the candidate's nomination will be considered
• Appear before the Credentials Committee on behalf of the candidate, if requested
• Complete and submit the online sponsor/co-sponsor nomination form.
  
  

Step 3: Log-in Credentials upon submitting online application

Upon submitting the application form and payment, the member candidate will receive a "Thank you for your membership application" email which will provide the candidate with their login information for the Academy website. At this time, the applicant will be granted guest-level privileges and will be able to login and edit their member profile, but will not have access to members-only pages.

Step 4: After being approved for membership, the AAFP Webmaster/Treasurer will:

• move the member profile into the appropriate membership category
• approve and provide the new member access to members-only materials through member-level access
• once approved, the candidate receives a "Welcome to AAFP Membership" welcome email

The American Academy of Fixed Prosthodontics

Membership Application

 Step 1: Personal Information

Honorific	== choose one == Dr. Mr. Ms. Mrs. Mx.
First Name
Last name
Preferred name
Gender	== choose one == male female non-binary prefer not to say
Date of birth
Citizenship
email
Home Information
Home address
Home city
State/Province/Other	== choose one == ==Canada== AB BC MB NB NL NS NT NU ON PE QC SK YT ===USA=== AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MR MS MT NC ND NE NH NJ NM NN NV NY OH OK OR PA PL PO PR RI SC SD TN TT TX UT VA VI VT WA WI WV WY ==other/international==
Country
Home Zip/Postal Code
Home Phone
Mobile
Primary Office Information	Please provide your practice address if you want to be included in the member directory
Practice name/Institution/Company
Primary Office address
Practice city
Practice state/province	== choose one == ===state=== Alabama Alaska Arizona Arkansas California Colorado Connecticut Washignton D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ===province=== British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Nunavut Yukon ===other=== N/A
Practice Zip/Postal Code
Practice Country
Practice phone
Practice fax
Practice email
Practice website

Step 2: Educational Information

Degrees earned (check all that apply)
DDS    DMD    MSD    PhD    MS    MA    BS    BA
Dental School Attended
City
State/Province/Other	== choose one == ===state=== Alabama Alaska Arizona Arkansas California Colorado Connecticut Washignton D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ===province=== British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Nunavut Yukon ===other=== N/A
Country
Year of Graduation
GPR/AEGD Training Program
City
State/Province/Other	== choose one == ===state=== Alabama Alaska Arizona Arkansas California Colorado Connecticut Washignton D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ===province=== British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Nunavut Yukon ===other=== N/A
Country
GPR/AEGD Year of Graduation
Specialty Training Program
City
State/Province/Other	== choose one == ===state=== Alabama Alaska Arizona Arkansas California Colorado Connecticut Washignton D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ===province=== British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Nunavut Yukon ===other=== N/A
Country
Year of Graduation

   

Specialty Training Program:	== choose one == Prosthodontics Other
Certified by the American Board of Prosthodontics?	Y    N
Year Certified
Board Eligible	== choose one == Yes No
Educationally Qualified	== choose one == Yes No
Recertification Date
Is the candidate certified by another ADA recognized specialty?	Yes    No
Year Certified
Board Eligible	== choose one == Yes No
Educationally Qualified	== choose one == Yes No
Recertification Date

Step 3: Professional Information

ADA membership number or International Equivalent if applicable
Professional Activity (check all that apply with percentages)
Private practice (PP) %
Public Health (PH) %
Consultant (CN) %
Military (MT) %
Education (ED) %
Hospital Dentist (HD)
Veterans Administration (VA) %
Administration (AD) %
Retired
Areas of Interest (check all that apply and place appropriate percentage of your total practice.)
Complete Dentures %
Tooth Supported Fixed Partial Dentures %
Temporomandibular Disorders %
Removable Partial Dentures %
Maxillofacial Prosthetics %
Fixed Implant Prostheses %
Implant Supported/Retained Removable Prostheses %
List Professional Memberships/Activities along with positions held and inclusive dates
List Faculty Appointments (Institution / Inclusive Dates / Academic Rank / Hours per Week)
List Lectures, Professional Presentations and Courses Given (last 2 years only)
List Continuing Education Courses Taken (last 2 years only) -Name of Course, Instructor, Location/Sponsor, Dates Attended(year)
List Scientific Articles Published (title, publication, date)
Guest Attendance: year(s) which nominee was a guest, essayist, or clinician of the Academy (AAFP)
Confidential Information:
Has the nominee ever been censured by any component of organized dentistry?	Yes    No
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.
Explain censure (if any)

Sponsor Information:

Primary Sponsor First Name
Primary Sponsor Last Name

 

Secondary Sponsor First Name
Secondary Sponsor Last Name

 

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