FACD Membership Application

Join the Florida Academy of Cosmetic Dentistry

2025-2026 Membership Application
The Florida Academy of Cosmetic Dentistry (FACD) is the premier state cosmetic dentistry organization. By becoming a member of FACD, you will be among an exclusive group of Florida dentists. Our member benefits and events are designed to advance your career and the cosmetic dentistry profession as a whole and are unlike any you find anywhere else.

Your Membership Benefits Include:
- Discounted Registration to the FACD Annual Session - August 27-29, 2026
- Exclusive Access to the FACD Hands-On Course - More info coming soon!
- Group buying discounts available to members from companies that work closely with our association.
- Your name and practice will be listed on the newly designed FACD website, giving you increased visibility to patients searching for a cosmetic dentist in their area.
Name:*

PrefixFirst NameLast Name
Designation (Example: DMD, DDS):*
If not applicable, please put N/A
Email:*
example@example.com
How did you hear about the FACD?*
If a current member reached out to you, please include their name.
Please select your membership type:*
Office/School Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accredited University or College:*
Office Phone Number:*
Please enter a valid phone number.
Practice Name*
Practice Website*
Practice Logo (for website directory)*

Cancelof
Home Address (For mailing purposes)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Preferred Mailing Address*

OfficeHome
Payment Type:*

CardCheck (If you would like an invoice please email us at facd.info@gmail.com)
Please make checks payable to:

Florida Academy of Cosmetic Dentistry | PO Box 4373 | Brandon, FL | 33509
Check Amount:
Check Number:

Card Payment:*

Membership Dues (Doctor/Lab Technician)

$500.00

Membership Dues (Full Time Faculty)Teaching staff of an accredited university or college, full-time.

$200.00

Membership Dues (Recent/Post Graduate) 1-2 years out of school

$100.00

Membership Dues (Student)Current student of an accredited university of school.

$50.00

Speaker Fund DonationThis is to support speakers for FACD related events.

$100.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Join the Florida Academy of Cosmetic Dentistry