Membership Application

Category of Membership

Select One:

  • Full Members (Complete sections 1-4)
  • Associate Member (Complete sections 1 and 2)
  • Individual Member (Complete section 1 only)

1. Contact Information

2. Names and Titles of Key Company Executives

(for plan and associates only)

3. Dental Plan Information Only

4. Delegate: Indicate person who will have authority from your company to vote on CADP Matters:


  • Associate Dues: $1,581 annually
  • Individual Dues: $220 annually
  • Plans: Based on weighted enrollment multiplied by per enrollee rate. Email for an estimate.
After submitting this form, Rene Chapin with CADP Membership will be contacting you for payment information.