AADE Membership Application
Note: Your dues must accompany this application. Also, if you are applying for Publication Membership you must 
enclose 3 copies of your publication for review by the Eligibility Committee.
Name: ___________________________________________________________________________________________________________
Address: _________________________________________________________________________________________________________
City: ___________________________________________________________ State _______________ Zip _________________________
Phone: __________________________________________________   Fax: __________________________________________________
E-mail: __________________________________________________________________________________________________________
Title:      _____Editor    _____Business Manager    _____Former Editor     _____Author     _____Executive Director     _____Teacher
_____Other (explain)_________________________________________________________________________________

Type of Membership You Are Applying For:
___Publication ($145)        ___Publication Assoc. ($ 50)        ___Student Publication  ($ 40)        ___Student Pub. Assoc. ($ 30)  
___Individual ($50)        Affiliate/International  (US$55)

Publication Qualification:
Publication Title:_____________________________________________________________________________________________________
Publisher (sponsoring organization or company): __________________________________________________________________________

Type of Publication: ___ State  ___ Component  ___ Specialty  ___ Foreign   ___ Commercial  ___ Alumni ___ Student   ___ Fraternal
___ Other (describe briefly)_________________________________________________________________________________________

Frequency of issue circulation:__________________________________  

Are you now affiliated with a publication: _____Yes   _____No         Have you been in the past? _____Yes  _____No

Does publication carry advertising? ___ Yes  ___ No

If YES, does it have an officially adopted advertising code?    ___ Yes    ___ No If YES, please enclose advertising code.

Does the sponsoring organization exercise complete control over the editorial and advertising content? ___ Yes  ___ No

Has the editor or publication been a prior member of AADE?   ___ Yes   ___ No

Dental organization memberships:_____________________________________________________

Please print application and send with dues payment to:
American Association of Dental Editors
750 North Lincoln Memorial Drive, Suite 422
Milwaukee, WI  53202
Fax: 414.272.2754

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