GA Dental Assoc.
2014 GDA Faculty Dues Renewal Form
This is the form for any GDA member in the Eastern District who is employed FULL TIME as a faculty member at an accredited Georgia college or university who also holds a valid Georgia dental teaching license or dental license. If you have questions about your membership category, please email GDA Director of Membership Pamela Yungk at firstname.lastname@example.org.
The GDA accepts only VISA and MasterCard for payments.
After completing the form, click Submit. This will lead you to a secure screen to enter your credit card information.
Dues payments and contributions are not deductible as charitable contributions for federal income tax purposes to the extent that payments are not made to 501(c)(3) organizations. U.S. taxpayers note: Under tax law, only that portion of an association member’s dues not attributable to lobbying activities is deductible as an ordinary and necessary business expense. For 2014, 7.5% of ADA dues and 5% of GDA dues are allocable to lobbying activities and, therefore, nondeductible as a business expense.
Dentist First Name
Dentist Middle Name
Dentist Last Name
Primary Street Address
Address Zip Code
Option 1: Pay your mandatory dues (District, GDA, and ADA) and voluntary dues in one easy step. Voluntary dues are GADPAC (160), GDA Relief Fund (35), GDA Foundation for Oral Health (25), GDA Alliance (75), GDA Alliance PAC (50), Fisher Dental Education Foundation (75), and charities specific to each district. A $5 convenience fee is added to each credit card transaction.
Select Your District Below
Option 2A: Use this option to pay your mandatory district, GDA, and ADA dues as well as make voluntary contributions. Just mark the check box next to those groups you wish to support. A $5 convenience fee is added to each credit card transaction.
If you paid an amount in Option 1, please do not select any payment items in Option 2.
To pay your mandatory dues in Option 2, select your district from the drop down list. Then, select the GDA dues amount and then the ADA dues amount. You may add voluntary contributions as you wish.
Select Your District
Option 2B: Pay Required GDA Dues (Must Also Pay District / ADA)
Select Your GDA Payment
Option 2C: Pay Required ADA Dues (Must Also Pay District / GDA)
Select Your ADA Payment
Option 2D: If you pay your District, GDA, and ADA dues under Option 2, you may choose to make voluntary contributions to any or all of these organizations.
GDA Alliance 75.00
GDA Foundation for Oral Health 25.00
GDA Alliance PAC 50.00
GDA Relief Fund 35.00
Fisher Dental Education Foundation 75.00
Rehoboth Dental Clinic (Central) 25.00
Macon Volunteer Clinic (Central) 25.00
Give Kids a Smile Day (Eastern) 10.00
Ben Massell Dental Clinic (Northern) 20.00
Greater Atlanta Dental Foundation (Northern) 25.00
Dentistry for Developmentally Disabled (NW) 25.00
Good Samaritan Dental Clinic Jasper (NW) 25.00
Savannah Volunteer Dental Clinic (SE) 25.00
Coastal Medical Access Dental Clinic (SE) 25.00
Kingdom Care Dental Clinic (SW) 25.00
Columbus Community Dental Clinic (W) 25.00
LaGrange Free Dental Clinic (W) 25.00
Do Not Fill This Out