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USA Section of the Academy of Dentistry International

Request Retired or Life Fellow Status

Please complete this form to submit your change of status request.

Your Contact Information

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In accordance with the Bylaws of the Academy; a Fellow in good standing may submit to the Central Office in writing a request of change in status to a Retired or Life Fellow. A Fellow in Good standing is current in the dues year the request is made.

Please select a reason for nominating this member.
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Requested change in status to apply to

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