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* Company Name:
* First Name:
* Last Name:
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Title:
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Company Information

Select only one. Questions: email Director of Membership Rene Chapin (rchapin@nadp.org).

Dental Plan
My company sells or administers dental benefits such as DPPO, Indemnity, DHMO, Discount, Medicaid/Medicare or ASO (Administrative Services Only). Read dental plan definitions and criteria here.

Note: NADP will follow up with you regarding Dec. 31 enrollment (employee + dependents) by product necessary to complete your application.

Dental Practice Management
My company is a dental practice management company that does not provide dental benefits as defined in the above dental plan definitions and criteria. Read criteria for this membership here.

Supplier
My company provides products or services to dental plans such as claims processing, consulting, etc. Read criteria for this membership here.

International
My company provides dental benefits outside the U.S. Read criteria for this membership here.

Other
I am a college professor; private practice dentist; or self-employed, one-person company that provides products or services to the dental benefits industry. Read criteria for this membership here.

Note: All categories of membership must
(a) subscribe to and support the purposes of the Association, i.e. to promote and advance the dental benefits industry to improve consumer access to affordable, quality dental care,
(b) meet any additional membership criteria approved by the Board, and
(c) stay current in the payment of dues.

While only Dental Plan Members may vote on Association business, members in all categories are eligible to serve on volunteer groups appointed by the Board, attend meetings of such groups and attend the Annual Business meeting.

Date Signed: Thursday, May 23, 2013

I agree with the above statement.