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

  • *A $75 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, Poe Center for Health Education, Wake Smiles, Wake County’s Children’s Dental Health Month, UNC SOD, NC MOM, 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, 2020 and are considered late if not paid by February 1, 2020

    MAKE YOUR DUES CHECK PAYABLE TO THE RALEIGH-WAKE COUNTY DENTAL SOCIETY AND MAIL TO:
    RALEIGH-WAKE COUNTY DENTAL SOCIETY c/o Dawn Harris
    6601 Cross Meadow Ct. Fuquay Varina, NC 27526

    For additional information: Please contact the Administrative Assistant, Dawn Harris [email protected] or 919-696-5156
  • This field is for validation purposes and should be left unchanged.