The Beacon for Choice in Dentistry
Any interested persons are welcome to
join AIDA. We ask on the honor system that groups of dentists
join as individuals so that AIDA may have the funding it needs to
pursue its invaluable goals.
Membership includes a subscription to Re-Organize
Dentistry, which is an informational and
thought provoking newsletter.
Re-Organize Dentistry is
published approximately monthly and is mirrored online.
AIDA encourages submissions of articles, editorials, and Templates for Success(TM).
To join, please print out this page, complete the Membership
Application and Conflict of Interest Statement (if indicated),
and remit with your Charter Membership dues to the address
included.
You are encouraged to make copies of the application to share
with like-minded dental professionals.
Membership of representatives from related professions and industries is welcome.
Dental members do not have to be members of organized dentistry to join AIDA initially.
Membership in the American Dental Association is a requirement for continued membership in the American Independent Dentist's Association. The reasoning is quite simple- we are looking to re-engineer our profession to make it more responsive to quality, freedom-of-choice dentistry. If you are to be a change agent, you must be involved in the organization. Join AIDA, follow the templates, become a learning individual, and develop influence in the profession. If, after two years of membership, AIDA hasn't created enough value for you to want to join and add to the changes in organized dentistry, then your membership will be dropped. Accept the challenge; the worst that could happen is that you will be awakened to new ideas.
USE THE PRINT BUTTON ON YOUR BROWSER
APPLICATION FOR MEMBERSHIP TO
THE AMERICAN INDEPENDENT DENTIST'S ASSOCIATION
NAME________________________________________________OCCUPATION_________________________
MAILING
ADDRESS__________________________________________________________________________
CITY, STATE,
ZIP____________________________________________________________________________
OFFICE PHONE____________________HOME
PHONE_____________________FAX_____________________
E-MAIL____________________________________WEB SITE
URL____________________________________
SPECIALTY___________________TYPE OF PRACTICE(solo, group,
institutional, industry, etc)_______________
AGE(OPTIONAL)_______ SEX(OPTIONAL)________DATE GRADUATED FROM
DENTAL SCHOOL_______
STATE DENTAL ASSOCIATION__________________LOCAL DENTAL
SOCIETY________________________
OTHER DENTAL
GROUPS______________________________________________________________________
DO YOU PARTICIPATE IN ANY REDUCED FEE DENTAL PLANS(HMO'S, PPO'S,
ETC)?___________________
WHICH
ONES?________________________________________________________________________________
HAVE YOU EVER SO PARTICIPATED IN THE PAST?____________________
WHICH
ONES?________________________________________________________________________________
WHY DID YOU
STOP?__________________________________________________________________________
_____________________________________________________________________________________________
DO YOU TREAT MEDICAID OR WELFARE PATIENTS?___________________
ANY SPECIAL REASONS WHY OR WHY
NOT?__________________________________________________________________________________________
DO YOU DESIRE HELP IN GUIDING YOUR PRACTICE AWAY FROM INSURANCE
DEPENDENCE?_________
DO YOU REPRESENT ANY GROUP THAT WOULD DESIRE AN AIDA LEADER AS A
SPEAKER?_____________
HOW MAY WE CONTACT THAT
GROUP?__________________________________________________________
DO YOU HAVE ANY COMMENTS, SUGGESTIONS, OR
QUESTIONS?___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please remit annual membership dues of $200 (students $50, first
year dentists $100)to:
AMERICAN INDEPENDENT DENTIST'S ASSOCIATION
336 Alhambra Circle
Coral Gables, Florida, USA 33134
Please use the
"BACK" button on your browser, or select 
to return to the Navigation Page.
Last Update 7/5/97