Join us!

This application reflects CADAT membership from 01-01-2021 through 12-31-2021. After reviewing the membership category descriptions on the membership page, please check one of the following categories for which you are applying or renewing. Complete all form fields with information required and submit the form. Afterwards, we request you to pay for your membership on the Membership payment page.

SECTION ONE Member Database Information

First Name *

Last Name *

Address *

City *

State/Province *

Zipcode *

Home Phone

Cell Phone

Primary E-mail Address *

SECTION TWO Licenses/Certifications

– Highlight all that apply and add the corresponding numbers below.
(Retired Applicants – Skip this section and go to Section #3
TIP: To highlight more than one, hold down the [ctrl] key.

Licenses/Certification

Type your dental board license # or DANB certification #s (verifiable)

Degrees/Academic Designations/Prof. Recognitions

Provide the name of the person serving as the current Program Director of the RDA or DA Program where you teach or serve as a divisional dean, administrator or manager. If a CE business owner, list yourself as the Course Director. A valid Program Director or Course Director is the person currently reported as such with the Dental Board of California.

Director Name:

Primary Work Location

Primary Work Mailing Address:

PW City

PW State

PW Zipcode

PW Phone number

Current Membership Status: (check one of the following choices)

Current Membership Status *

SECTION THREE Membership Terms and Agreement

Applicants: Review the following policy statements and check each box acknowledging your acceptance and understanding of each. Please do not complete this section without having reviewed all pertinent information.

By-Laws | More forms & applications

Terms and Agreement

I have read through, understand and accept the terms and conditions of membership including the definitions used for identifying my membership category and annual dues for the member category I have selected.

I understand and accept that CADAT reserves the right to reject membership applications or renewals at any time and are under no obligation to renew a membership

I am aware that the CADAT Bylaws are available on the website and will access them to review the policies and principles of the Association. Upon review, I agree to uphold and hold true the Bylaws of the Association by deeds and actions causing no harm to the Association or its membership.

I understand that dues are non-refundable and non-transferrable, that my membership is mine, and that no other person or persons may use my member benefits without the express written consent of the Association.

I have read and accept the CADAT Code of Conduct and agree to abide by such code as a member of the allied health teaching profession and the Association.

I understand that the processing of credit/debit card information provided on this application is my responsibility or that of the person authorizing the use of such data in the payment of these dues. The authorizing signatory is approving such charge and any dispute of a charge to the account shall be reported and resolved by contacting the Association prior to any dispute filing with the card company. Should a charge be disputed or voided without contacting the organization to resolve the matter, a service fee of $35 shall be charged to the member for fees incurred by the Association.

I understand that all membership data of the Association is private information. I understand that should I come to obtain membership data that it may not be used, distributed, published, reported or sold to anyone, any business or other entity, or used by me for any purpose including the purposes of sales, marketing, advertising or promotion of any kind. I agree to abide by such privacy policies and understand that the Association will protect the privacy of all members to the fullest extent of the law.

Notice to Membership Applicants: Be advised that the association volunteers do not always process membership applications immediately upon receipt. Verification letters, receipts, and membership packets are not issued until payment processing is completed which may be up to four weeks after application forms are received. While we strive to process documentation in a timely manner, the organizations limited workforce may not always be able to provide membership verification letters or charge receipts within 30 days. Institutions requiring such documentation are encouraged to accept credit card statements or canceled checks as verification of the date of payment processing.

A membership application fee will not be processed prior to verification of membership eligibility. Should payment processing occur, and an applicant is determined to not qualify as a member, a refund will be issued and member enrollment processing stopped.

Acceptable payment methods:

Pay Online: Credit/debit cards; requires 3-digit security code from back of card (Am Express: 4-digit code on front of card).
Institutional or business checks accepted.
No personal checks will be accepted; cashier’s checks and money orders accepted.
Purchase orders cannot be accepted for membership fees.

SECTION FOUR Membership Dues Payment

Credit card - After you submit this online form, pay using our online payment form.
Institutional or business checks accepted. - After you submit this online form, send your check to: CADAT, 710 S. Myrtle Ave. #166, Monrovia, CA 91016

CADAT

The California Association of Dental Assisting Teachers

Membership form

Join us!

SECTION ONE Member Database Information

SECTION TWO Licenses/Certifications

SECTION THREE Membership Terms and Agreement

SECTION FOUR Membership Dues Payment