Membership form

Join us!

This application reflects CADAT membership from 01-01-19 through 12-31-19. 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, you may pay for your membership on the Membership payment page.

SECTION ONE Member Database Information


 
 
 
 
 
 

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.


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.

Current Membership Status: (check one of the following choices)
In order to serve the needs of our members most effectively, please indicate if you have any opt-out preferences:
 
 

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.

Code of Conduct | By-Laws | More forms & applications
 
 
 
 
 
 
 

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