Association‌ of‌ State‌ &‌ Territorial‌ Dental‌ Directors
3858‌ Cashill Blvd.,‌ Reno,‌ NV‌ ‌89509
Phone‌ 775-626-5008‌‌

New Associate Membership

2018 Associate Membership/Organizational Membership

ASTDD is an affiliate of the Association of State and Territorial Health Officials.
Thank you for your interest in Associate Membership or Organizational Membership in ASTDD.
Your email, {{member.email}}, has been successfully verified.
Please take a moment to complete the form below.
Please allow us a moment to check your confirmation code.
A verification email has just been sent to you at {{email}}. Please retrieve this email and follow the instructions outlined within to complete your membership application.
Unable to verify {{confirmEmail}}. Please try again using the form below. Thank you.
To begin your application let's first take a moment to confirm your email address. This email address will be used as your username to login to Astdd.org. Please enter your preferred email address below and click "Confirm Email Address".
Confirm email address
Email *
Sending verification email....please wait.
This email address is already associated with a member account in ASTDD.
Please use the Login Form to access this account.
If you have any questions or concerns please contact us.
There was an error trying to send a verification email to you at {{email}}. If you have any questions or concerns please contact us.
Membership status
Your account is not presently associated with a membership level which requires membership renewal.
You may now renew your 2018 ASTDD associate membership. To renew, please review your contact and billing information, update if necessary, and provide the required credit card information
{{form.mode === "new"?"Please select your desired membership":"Your membership"}}Price
{{membership.name}}{{membership.amount | currency:'':2}}
As an Organizational Member of ASTDD you are allotted up to four Associate Memberships for individuals within your organization. Please complete the contact information below for your organization as well as those individuals who you would like to make Associate Members.
Organizational Contact Information for the ASTDD Website Roster
Name - First, Last *
Degree(s)
Title
Company/Agency
Organization
*
Street *
*
City *
State/Territory *
Country *
Zip *
Phone *
Fax
Associate Members
How many Associate Members would you like to register?
{{i}}
Remove
Associate Member {{i}}
{{member.associates[i-1].fname}} {{member.associates[i-1].lname}}
Name - First, Last *
Degree(s)
Title
Company/Agency *
Street *
City *
State/Territory *
Country *
Zip *
Phone *
Fax
Email *
This email is already assigned to a member in the database.
Billing Information
Select this box if your billing information is the same
Organization *
Name - First, Last *
Street *
City *
State/Territory *
Country *
Zip *
Phone *
Payment Information
Amount Due{{ billing.amount | currency:'$':2}}
Card Number
*
Expiration Date / *
Credit Card Code (CVV) *Where is my CVV code?
Agreement*I agree that I have read and comply with this website's Terms and Conditions
* This information is required in order to complete an online transaction.
 border=