Member Application

Membership Application

Becoming a member or renewing? Its easy! Submit your application below left and then submit your payment using one of our two options listed on the right. If you have any questions, please email us for a prompt response at [email protected]

1) Apply for Membership

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

License # *

Doctor/CDT: *

Staff *

Number of Doctors/CDT's Applying for [SEDA] Membership: *

Number of Staff Applying for [SEDA] Membership: *

Submit Membership Application

2) Submit Membership Fee(s)

Please calculate your total using these fees:

Doctors, CDTs & Industry Representatives:

$300.00 each

Practice Auxiliaries:

$85.00 each
(per meeting only)

Option A: Credit Card / Paypal

Option B: Pay by Check

If you are mailing a check for your membership, please tally the amount based on the number of applicants, make your check payable to "[SEDA]", and send it to:

     SEDA
     P.O. Box 174
     Portsmouth, NH 03802