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AGD Student Membership Virtual Application

Bulk Submission Form

To streamline the bulk application process for students whose membership dues are getting sponsored, please use this virtual application form instead of the paper version. Once all the student applications have been summitted by your student members via this form, please alert AGD by emailing students@agd.org. Once payment is received, applicants will be a member of the AGD.

If you are self-paying, please visit www.agd.org/membership to join or renew with AGD.
1.First Name:(Required.)
2.Middle Initial:
3.Last Name:(Required.)
4.Street Address:(Required.)
5.City:(Required.)
6.State(Required.)
7.Zip Code:(Required.)
8.Phone Number:(Required.)
9.School Email:(Required.)
10.Personal Email (not a .edu email address):(Required.)
11.Date of Birth:(Required.)
12.Graduation Year:(Required.)
13.Dental School(Required.)
Privacy Information—The AGD knows that you value your privacy, and we appreciate your trust. The AGD treats the handling of your personal information very seriously. The organization has systems and procedures in place to protect your privacy when handling your personal information. The AGD does not collect personal information unless it is necessary to perform one or more of its functions and activities. On occasion, sensitive personal information may be collected with your consent or when required by law.
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