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TDA Membership Application

Please complete the application below. Contact Rachael Daigle in the TDA Member Services department with any questions, (512) 443-3675, rachael@tda.org.


If you do not know which Component Society you belong to, please review: Counties in Component Societies


























(Office address is used for component society assignment – Primary address is used for mailing purposes) 















































I hereby certify that the information contained herein is true and correct and if subsequently proved incorrect shall be grounds for disapproval and/or removal. I authorize the Component Dental society membership chairman to seek any information concerning my candidacy for membership in the American Dental Association, the Texas Dental Association and the Component Dental Society and authorize the release of any such information for use in connection with this application to those people who are involved in the membership process. 

I certify that I have received a copy of the Constitution and Bylaws, Principles and Ethics and the Code of Professional Conduct of the American Dental Association, Texas Dental Association, and Component Society and agree to abide by the tenets of these documents. I understand that failure to abide by such can result in disciplinary action. I am aware that if my application is not approved, or in the future my membership is rescinded, I can appeal the action. 


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