AMERICAN
ASSOCIATION OF DENTAL EDITORS
Application for CDE Recognition
This
is your application for CDE recognition.
It should be submitted only after you have completed all CDE
designation requirements.
The deadline each year for consideration is July 1st.
CDE designations are awarded each fall at the AADE Annual Conference.
YOUR
NAME:____________________________________________________________________
DENTAL
PUBLICATION:_________________________________________________________
BUSINESS
ADDRESS:__________________________________________________________
ARE
YOU CURRENTLY AN AADE MEMBER?
____YES
____NO
BUSINESS
TEL #:_____________________
FAX:_______________________
HOME
TEL#:__________________
E-MAIL:____________________________
JOURNALISM CONTINUING EDUCATION HOURS ACHIEVED:
Please complete the requested
information below. Attach evidence
of completion of continuing education activities to this application.
Evidence can include a copy of a certificate, verification form or letter
from a granting organization that states the title of the meeting or course,
location, date(s), number of continuing education hours and the instructor(s)
name(s).
Subject
codes for continuing education hours are as follows:
01
General Journalism Topics
02
Writing
03
Editing
04
Layout and Design
05
Editorial Leadership
06
Communications
Course/Meeting Title:______________________________________________________________
Date(s):______________
Sponsor:____________________________________
#
of Completed CE Hours and Subject Codes:
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
Course/Meeting Title:________________________________________________
Date(s):_________________
Sponsor:_________________________________
# of Completed CE Hours and
Subject Codes:
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
Course/Meeting Title:________________________________________________
Date(s):_________________
Sponsor:_________________________________
# of Completed CE Hours and
Subject Codes:
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
Course/Meeting Title:________________________________________________
Date(s):_________________
Sponsor:_________________________________
# of Completed CE Hours and
Subject Codes:
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
_______Hours ______Code
Course/Meeting Title:________________________________________________
Date(s):_________________ Sponsor:_________________________________
_______Hours
______Code
_______Hours
______Code
_______Hours
______Code
_______Hours
______Code
The
following number of CE hours from the courses or meetings that I attended and am
reporting were sponsored by a dental organization: _______Hours
I
attest that the information I am providing is truthful.
YOUR SIGNATURE: _________________________________ DATE:__________
Mail the completed application, supporting evidence attachments and a check for
$150.00
made payable to: “American Association of Dental Editors” before July 1,
2005 to:
American
Association of Dental Editors
750 North Lincoln Memorial Drive, Suite 422
Milwaukee, WI 53202 USA