EmailMe Form - GDA 2026 Membership Renewal Form

Member Name *
First Last
ADA Member Number
Don't know your ADA number? No, problem...we'll fill this in.
Which best describes you?
I am ready to renew my membership today.
I have retired from dentistry. Please send me a retired affidavit, so I can change my membership status.
I have moved and no longer practice dentistry in the State of Georgia.
Which district are you a part of? *
Payment Information
*Please note that dues amounts listed do not reflect any specialty dues rates including faculty, retirement, life membership, etc. Discounts and specialty rates will be reflected in final, processed payments.
2026 Membership Summary:
ADA: $627, GDA: $575, Central District: $115

Total 2026 Membership Dues: $1,317 annually/ $109.75 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Eastern District: $75

Total 2026 Membership Dues: $1,277 annually/ $106.42 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Northern District: $155

Total 2026 Membership Dues: $1,357 annually/ $113.08 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Northwestern District: $90

Total 2026 Membership Dues: $1,292 annually/ $107.67 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Southeastern District: $75

Total 2026 Membership Dues: $1,277 annually/ $106.42 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Southwestern District: $55

Total 2026 Membership Dues: $1,257 annually/ $104.75 per month
2026 Membership Summary:
ADA: $627, GDA: $575, Western District: $85

Total 2026 Membership Dues: $1,287 annually/ $107.25 per month
Membership Payment Options:
Please select how you would like to pay for your 2026 membership. *
1 payment: Pay-in-full
12 monthly payments
6 installment payments
Payment Information
Please fill out your billing information below.
Name on Card *
First Last
Credit Card

Card Number

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Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Is this the address you'd like your membership certificate and decal to come to? *
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No
Preferred Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Cardholder Phone Number *
### - ### - ####
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Authorization of Future Payment
I authorize the GDA to set my membership to auto-renew. Voluntary contributions will remain the same unless I specify otherwise.
Uncheck the box if you do not agree.
Approval to Charge Credit Card:
By signing the below, you are authorizing GDA to charge your card for your 2026 membership renewal dues and any voluntary donations you have selected. A receipt will be sent to the email address provided above.

If you selected monthly payments, you agree and grant permission for the GDA to charge your card in six or twelve payments for the dues. If the payments are not completed, in full, by the end of the membership year, membership shall be voided and any partial dues shall be forfeited.
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Voluntary Donations:

If you do not want to make any voluntary donations, simply leave all fields blank and click the submit button at the bottom of the page.

GDA Voluntary Dues:

GDAPAC
GDA Foundation for Oral Health
Member Relief Fund
Emile T. Fisher Foundation

CDDS Voluntary Dues:
Macon Volunteer Clinic - $25
Rehoboth Life Care Ministry Dental Clinic - $25
All donations go directly to the clinic.
EDDS Voluntary Dues:
Give a Smile Foundation - $25
All donations go directly to the clinic.
NDDS Voluntary Dues:
Ben Massell Clinic - $20
Greater Atlanta Dental Foundation - $25
All donations go directly to the clinic.
NWDDS Voluntary Dues:
Greater Atlanta Dental Foundation - $25
All donations go directly to the clinic.
SEDDS Voluntary Dues:
Savannah Volunteer Dental Clinic - $25
All donations go directly to the clinic.
SWDDS Voluntary Dues:
Kingdom Care - $25
Broadfoot Dental Clinic for the Uninsured - $25
All donations go directly to the clinic.
WDDS Voluntary Dues:
LaGrange Free Dental - $25
MercyMed Of Columbus - $25
All donations go directly to the clinic.

Payment Information

2026 Membership Summary:

2026 Membership Summary:

2026 Membership Summary:

2026 Membership Summary:

2026 Membership Summary:

2026 Membership Summary:

2026 Membership Summary:

Membership Payment Options:

Payment Information

Approval to Charge Credit Card:

Voluntary Donations: