Membership Application Form

This membership form is only for NEW Applications only. If you are renewing your membership. Please visit here.

Membership Application and Dues Statement

PLEASE NOTE: ALL MEMBERS (INCLUDING LIFE MEMBERS) MUST COMPLETE THIS FORM ANNUALLY. PLEASE HIGHLIGHT NEW OR RECENTLY CHANGED INFORMATION.
  • (Choose One)
  • (Dental School Attended/Degree)
  • (Advanced or Specialty Training/School)
  • Membership Classifications

  • *An $85 voluntary contribution to the RWCDS Foundation is included. The Foundation is a 501(c)(3) organization and donations are tax-deductible. Among other dental health-related endeavors, the Foundation is supportive of Wake Tech’s Hygiene Assisting programs, Wake Smiles, Wake County’s Children’s Dental Health Month, UNC SOD, and Give Kids A Smile Day.

    Please increase or decrease the amount of your donation as you deem appropriate.

    Dues are due on or before January 1, 2021, and are considered late if not paid by February 1, 2021

    PLEASE PAY YOUR DUES VIA PAYPAL OR A CHECK PAYABLE TO THE RALEIGH-WAKE COUNTY DENTAL SOCIETY AND MAIL TO:
    RALEIGH-WAKE COUNTY DENTAL SOCIETY c/o Kimberly Lee
    206 ROUNDHOUSE LN MORRISVILLE NC 27560-6138

    For additional information: Please contact the Administrative Assistant, Kimberly Lee [email protected] or (706) 551-0623
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