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Posts

Accountability on the Job
Yankee 2017 Day Two
21 Tips for a Great Wait
Clearing the Managerial Clutter
Yankee 17 Spending the Day with Professionals
Check Out Our February 2017 Featured Member
Yankee 2017 - That's a Wrap
You Cannot Hide the Vibe!
It's All In the Name
Meet Our April Rockstar Member!
Forecasting for Your Practice
It's Your Career. Take Control.
Tips For Empowering Office Managers [Podcast]
Dentistry Uncensored With Howard Farran [Podcast]
AADOM and the Kitchen Sink
AADOM's March 2017 Member Spotlight
How To Start a Movement in the Dental Industry [Podcast]
3 Things I Know FOR SURE...
You Are Not On An Island
Who Needs a Mentor?
The Thriving Dentist with Gary Takacs [Podcast]
The Challenges of Growing Your Team
The Benefits of Mentorship
How To Increase Productivity and Motivation In Your Employees
AADOM's Shining a Spotlight
10 Tips for Building Long-Lasting Business Success
When One Employee Knows "It All"
Learning About AADOM's May Featured Member
You're a Rockstar and We Know It!
Meet Our July Spotlighted Member
Check Out Our January 2017 Featured Member
Happy 2017 - Heather's New Years Greeting
We're Headed to Yankee 2017
Show What You Know - Help Others Grow!
5 Resources You’ll Love on AADOM’s New Website

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Phone: 732-842-9977

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Want to start a local AADOM chapter?

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Starting a local chapter is a rewarding endeavor. It requires some planning, resources and a little bit of elbow grease, but we are confident as an active AADOM Member, you already have what it takes to start a local chapter. If you're interested in starting a local chapter, please complete the form and an AADOM team member will contact you within 48 hours.
Name (First and Last):*
Phone Number:*
Email*
Your Location*
City State / Province / Region ZIP / Postal Code Country

I am an active AADOM member.*
- Yes
- No
- Not sure
I understand that starting a local chapter requires commitment and adherence to chapter guidelines:*
- Yes
I understand that as a new chapter, 100% of my members must be AADOM members, and I understand that my chapter members will receive a discount on national membership.*
- Yes
I understand that our annual chapter dues to AADOM are $150, and that the initial first year payment is due at the start of the calendar year following formation of the chapter.*
- Yes
I understand that as a local chapter, we must submit a roster to AADOM annually for cross reference of members.*
- Yes
I understand that as an AADOM local chapter I will have access to AADOM national resources to promote my chapter.*
- Yes
I understand that as Chapter President, I must currently be working as a full-time dental office manager/practice administrator.*
- Yes
I understand that AADOM will not approve a local chapter that is within a 90 minute driving radius of a current AADOM Chapter.*
- Yes
I understand that the chapter must be set up as a non-profit group and that I will receive more information on the non-profit status and process in my training as a chapter president.*
- Yes

Comment:
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Roadside Dental Marketing - SEO Performance Request

Name*
First Last
Website Address*
Email*
I Want My Custom Competitor Analysis In:
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2017 Practice Administrator of the Year Nomination Form

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Tell us why you feel your Practice Administrator should win the AADOM Practice Administrator of the Year award in 1000 words or less. Please note that nominations must come from the doctor or team member. Multiple nominations may be submitted from one office.

To be eligible, nominees must be an AADOM member and attend the AADOM Dental Managers Conference to be held in Scottsdale, AZ , September 7-9, 2017. The winner will receive $1,000, free conference registration to the 2018 conference and will be featured on the cover of THE OBSERVER magazine. Please assure that the nominee, practice principal, and team are aware of the nomination.

Deadline for submissions is July 7, 2017
Sponsored by CareCredit.

The AADOM 2017 Practice Administrator of the Year Award will be presented at the Conference. For more information email us at info@dentalmanagers.com or contact an AADOM representative at 732-842-9977.
Your Information
Name*
First Last
Email*
Please indicate your position in the office.*
Nominee Information
Nominee's Name*
First Last
Nominee's Title*
Practice Information
Practice Name*
Practice Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nomination Letter

In 1000 words or less, tell us why your nominee should be Practice Administrator of the Year. Please provide specific examples of how the nominee has positively impacted the business results of the practice and community.
Enter your nomination here.
I affirm that my nominee is an AADOM Member and is attending the 2017 Conference.*
- Yes
While a photo is not required you are welcome to submit one of your nominee. Please upload a .jpg file.
Accepted file types: jpg.
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For Speakers/Consultants

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We are currently accepting speaker proposals for future conferences and AADOM events. Please complete the form below and submit. We will contact you if we have a speaking opportunity for you. Thanks for your interest in working with AADOM!
Name*
First Last
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Website*
Email*
Topics on which you speak (list all)*
Do you have any upcoming speaking dates in the dental industry?*
- Yes
- No
Please list them

Do you have video on your website or online that we can view?*
- Yes
- No
Are you a member of AADOM?*
- Yes
- No
Are you currently a member of: (click all that apply)*
- Speaking Consulting Network (SCN)
- Academy of Dental Practice Management Consultants (ADMC)
- I'm not a member of ADMC or SCN
Please list any other speaking or consulting groups of which you are a member.*
Please list any dental organizations of which you are a member.*
Are you certified to provide CE through the ADA or AGD?*
- Yes
- No
Are you certified through any other organizations to provide CE?*
- Yes
- No
Are any of your courses approved for AADOM CE? FAADOM approved courses are promoted via the AADOM network.*
- Yes
- No
Anything else we should know?

Member Spotlight Application

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Every month, AADOM highlights one of our amazing members. Would you like to be featured in our monthly member spotlight?

Please complete the AADOM Member Spotlight form below and submit. We will review and choose one member each month to highlight. If you have any questions, please contact us at info@dentalmanagers.com or by phone at 732-842-9977.
Member Information
Your Name*
First Last
Practice Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Office Number*

Member Spotlight Questions
What type of practice do you manage? (general or specialized)*
What is your title?*
How long have you been with this practice?*
What are your main responsibilities within your practice?*
What is the most rewarding part of your career?*
What do you feel are some of the best AADOM benefits of membership?*
What other services would you like to see AADOM provide to dental office managers?*

Have you ever attended an AADOM conference?*
- Yes
- No
Can you tell us about your experience?*
Do you plan on attending the 2017 Conference?*
Are you a Fellow or are you pursuring Fellowship?*
What practice management software do you use?*
What company do you order the majority of your dental supplies from?*
Do you or your practice support any charitable organizations or events?*
What are some of your hobbies/interests outside of work?*
Upload your picture
Accepted file types: jpg.
Upload your team picture
Accepted file types: jpg.
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Work With Us - Become a Sponsor

Name:*
Company:*
Your Title:*
Marketing Manager Name:*
Trade-show Manager Name:*
Phone Number:*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Business:*
Website Address:*
Has your company exhibited with AADOM in the past?*
- Yes
- No
Would you like to register for our 2017 conference?*
- Yes
- No
I would like to receive information on other AADOM media or sponsorship opportunities.*
- Yes
- No
Are you a member of? (Check all that apply)*
- ADMC- Academy of Dental Management Consultants
- SCN- Speaking Consulting Network
- ASCA- AADOM Speaker/Consultant Alliance
- I am not a member of any of the above
How did you hear about AADOM?
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Green Leader Nomination - 2017

Step 1 of 4

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Your Information
First Name:*
Last Name:*
Email Address:*
Your Position in the Office:*

Nominee Information
First Name:*
Last Name:*
Position:*
Practice Name:*

Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is Nominee An AADOM Member?*
- Yes
- No
- Not Sure
Is Nominee Attending the 12th Annual Dental Managers Conference?*
- Yes
- No
- Not Sure

Green Leader Nomination

In 1000 words or less tell us why you are making this nomination - please provide specific examples of how the nominee has used a “green mindset” or green products in the dental practice.
Nomination Letter:*
I attest to the truth and validity of the attached statements substantiating this nomination.*
- Yes
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Collateral Request - Member

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Please complete the form below to request AADOM promotional materials to be utilized at your upcoming event! Forms must be received at least 14 days prior to the event. If special shipping is required in order to meet the event date, requester will be billed for additional charges.
Name*
First Last
I am an: (select all that apply)
Email*
Phone*
Name of event*
Expected Attendance*
Date of event*
Please ship materials to:
Business (if applicable)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Attention*
First Last
Date items need to be received by:*

Pkg-25 AADOM Membership Applications/Benefits Message
Price: $0.00 Quantity:
Pkg-25 New Member Benefits Flyer
Price: $0.00 Quantity:
Pkg-25 Foundations of Dental Practice Management Flyers
Price: $0.00 Quantity:
Pkg-25 Insurance Essentials Flyers
Price: $0.00 Quantity:
Pkg-25 FAADOM Requirements Flyer
Price: $0.00 Quantity:
Pkg-25 2017 Conference Flyer
Price: $0.00 Quantity:
Pkg-25 AADOM Mini Observer (25 Maximum)
Price: $0.00 Quantity:
Pkg-25 AADOM Presentation Folders (25 Maximum)
Price: $0.00 Quantity:
Special Instructions/Notes

Collateral Request - Sponsor

Step 1 of 2

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Please complete the form below to request AADOM promotional materials to share with your best customers! Please allow 14 days for materials to be shipped.
Name*
First Last
Company Name*
I am a: (select all that apply)*
Email*
Phone*
Please ship materials to:
Business (if applicable)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Attention*
First Last
Date items need to be received by:*

I (heart) AADOM Cards
Price: $0.00 Quantity:
Pkg-25 AADOM Membership Applications/Benefits Message
Price: $0.00 Quantity:
Pkg-25 New Member Benefits Flyer
Price: $0.00 Quantity:
Pkg-25 Foundations of Dental Practice Management Flyers
Price: $0.00 Quantity:
Pkg-25 Insurance Essentials Flyers
Price: $0.00 Quantity:
Pkg-25 AADOM17 Conference Flyer
Price: $0.00 Quantity:
Pkg-25 FAADOM Requirements Flyer
Price: $0.00 Quantity:
Pkg-25 AADOM Mini Observer
Price: $0.00 Quantity:
Special Instructions/Notes

CEDR - Handbook Offer

Welcome CEDR Clients! Congratulations on completing your employee handbook evaluation! Just for completing this evaluation, you are receiving your first year of membership to the largest professional association dedicated to dental practice management professionals in the country, at no charge to you. This is a gift to you from CEDR HR Solutions and we're happy you're with us! Please complete the form below and submit. You will receive a confirmation email from an AADOM representative when your membership application has been processed.
Name*
First Last
Title*
Name of Dental Practice*
Practice Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Office Phone*
Office Fax*
Email
Practice Website*
Type of Practice*
Are you currently an AADOM member?*
- Yes
- No
- Not Sure
Are you a local AADOM chapter member?*
- Yes
- No
If yes provide chapter discount code*

Corporate Membership Submission Form

AADOM Corporate Membership includes:
Listing in our AADOM directory
Listing on our Chapter sponsor page
Listing in three issues of the Observer magazine with link
10% on all AADOM Media Kit Offerings
If you're interested in becoming a corporate member or in finding out more information about corporate membership, please fill out the form below. You will be contacted by an AADOM team member within 2 business days. Contact Karin Bennett, National Sales Executive at (732) 842-9977, ext. 5 if you have any questions.
Date*
Business or Company Name*
Company Representative Name*
First Last
Title*
Phone*
Email*
Company Website*
Please provide general details about your business, and its products and/or services. **
What region does your company service? Check all that apply*
Are you interested in becoming an AADOM corporate member?*
I'm interested in finding out about the AADOM Annual Conference and other advertising opportunities:*
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Chapter Introduction Form

Did you notice a sponsor logo for a business that your chapter is interested in working with as a supporting sponsor? Please fill out the form below. You will receive sponsor contact information within 2 business days. Contact Lisa Kelly, Membership Development Coordinator at (732) 842-9977 ext. 1000 if you have any questions. Provide information about your chapter and which business(es) you're interested in working with.
Date
Chapter Name*
Your Name*
First Last
Phone*
Email*
My chapter is interested in contacting and working with additional AADOM Supporting Sponsors.*
- Yes
- No
Please describe your chapter sponsorship needs.*
I would like to receive contact information for the following sponsors:*
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New Sponsor or Exhibitor Chapter Referral

Local Chapters participating in the Chapter of the Year program can earn 10 points for each NEW sponsor/exhibitor referred to the national association. If you have a company or business you believe would be a potential new sponsor and/or exhibitor for AADOM, please complete the information below and if the business is determined to meet the criteria of a new sponsor/exhibitor, 10 points will be awarded to your chapter. Contact us at info@dentalmanagers.com if you have any questions.
Date*
Your Name*
First Last
Phone*
Email*
I am an AADOM Chapter Member*
- Yes
- No
Chapter Name*
What is your role with the Chapter?*
Company Name of Potential Sponsor/Exhibitor*
Product or service provided by potential sponsor/exhibitor:*
Company contact name:*
First Last
Contact phone:*
Contact email:*
Please provide detailed information about your interaction with this company:*
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Chapter Happenings Submission Form

Local Chapters participating in the Chapter of the Year program can earn 5 points for a Chapter Happenings submission for the next Observer Magazine. Tell us about upcoming events and current news from your chapter. Include information about upcoming meetings/events, guest speakers, changes or additions to your board members, chapter member receiving professional recognition, etc. Contact us at info@dentalmanagers.com if you have any questions.
Date
Your Name*
First Last
Phone*
Email*
Chapter Name*
What is your role in the Chapter?*
Share news from your chapter. Provide a recap of events or happenings, remember to include date, location, type of event, speakers, etc. The more info the better!*
Upload images from your chapter event, (limit of 3).
Drop files here or

Non Dues Revenue - Weekly Team Report

Date*
Weekly Tasks - Roger*
Weekly Tasks - Karin*
Conference Booth Space - Sold, Bartered, Still Available*
Weekly Tasks - Trish*
Weekly Tasks - Lorie*
Time off - FYI's - Special Requests
Industry Sponsor News
Blog Idea Suggestions

Upcoming Chapter Meeting Info Form

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AADOM Local Chapters are provided support at the national level. Our goal is to assist each chapter by communicating as much information as possible to members in the local areas. If you have an upcoming chapter meeting we want to share this information on our website and via our social media channels. Please complete the information below and if available, provide an image of your meeting flyer. We'll add your meeting to our national calendar within 48 hours of your submission. Contact us at info@dentalmanagers.com if you have any questions.
Chapter Name*
Your Name*
First Last
Phone*
Email*
What is your role in the Chapter?*
Date of the meeting*
Time of the meeting (from when to when):*
Meeting Location Name
Meeting Location Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Meeting Topic*
Speaker:*
Details About the Presentation:*
For CE purposes, how long is the educational portion of the meeting?*
Are you co-hosting this meeting with another AADOM Chapter*
- No
- Yes
If you are co-hosting this meeting, please provide the name of the co-hosting AADOM Chapter:
Meeting Sponsors? (Please enter N/A if none)*
Will food or beverage be provided?*
- Yes
- No
If providing food or beverage please give details:
RSVP Information:*
Please upload event image or flyer:
Please upload event image or flyer:
Please upload event image or flyer:
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CE Submission Form

Use this form to record CE for an event you attended or participated in. Please note, if you attended an AADOM sponsored event live, there is no need to complete this form, we have already applied the CE to your member profile. To see a full report of all CE in your membership data, click here.
Name*
First Last
Email*
Office Phone*
How did you acquire this CE?*
Name of Course, Event or Webinar*
Date of Completion*

Date format is mm/dd/yyyy
Number of Approved CE*
CE Code Provided at Conclusion of Event or Webinar*
Upload AGD or CERP Certificate (s) (if applicable)
Drop files here or

Accepted file types: jpg, pdf, png.
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AADOM Article Submission Form

Submission Check Off List
Article should be submitted in a word doc format.
Word count 500 - 1200 words.
Graphics can be submitted but are not guaranteed to be used.
Include bio of less than 75 words.
Include hi-res image of author.
Author Name*
First Last
Email
Phone*
Are you an AADOM Member*
- Yes
- No
- No, but I'm interested in joining!
Upload Article Here*
Upload High-Res Headshot Here - An image that measures at least 4" wide by 4" tall, and is at least 300 pixels per inch resolution*
Accepted file types: jpg.
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AADOM Webinar Information Form

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Thank you for being a resource for our members by providing an educational webinar. Please complete the information below, providing as much detail as possible so that we might promote this session accurately to our members.
Company Name*
Company Contact Name*
Contact Email*
Contact Phone*
Webinar Date*
Title of Webinar*
Speaker Name & Title*
Speaker Email*
Please upload head shot of speaker (minimum of 500 x 500 pixels)
Drop files here or

Accepted file types: jpg, gif, png.
Speaker Bio*

Course Summary*
Course Learning Objectives*
Please provide up to five registrations questions:*
Provide question verbiage as well as type of answer being requested (multiple choice, yes/no, open text. If multiple choice, provide answer selections)
Please provide up to three post webinar survey questions:*
Provide question verbiage as well as type of answer being requested (multiple choice, yes/no, open text. If multiple choice, provide answer selections)
Will there be additional panelists in addition to speaker?*
- No
- Yes
Please provide email addresses of additional panelists
Do you have handouts for attendees? Please upload here.

AADOM has a strict webinar protocol to assure content guidelines and timelines are met. Please review each statement below and mark the "I agree" statement to submit your webinar information.
All power point decks, polling questions and other components related to webinars and dry runs must be received by the deadlines set forth in the webinar worksheet sent prior to promotion of the event. Failure to submit on time may result in cancellation of the webinar. If cancellation occurs due to missed deadlines, AADOM is not required to reschedule webinar.*
- I Agree
The power point deck submitted for the dry run must be the final power point deck. Any changes made to the deck due to discovery during the dry run must be resubmitted to AADOM no more than 48 hours following the dry run.*
- I Agree
Sponsors are responsible for assigning a non-AADOM moderator for questions received from attendees during the webinar.*
- I Agree
I understand that attendee contact information provided to our company following the webinar may only be used to provide the specific information requested by the attendee and may not be used for future solicitation.*
- I Agree
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Going Green Nomination Form

I am the person nominating the 2017 Green Leader*
First Last
Email address to be contacted for information or inquiries*
Please indicate YOUR position in the Practice*
Nominee Information
Name*
First Last
Position*
Is Nominee an AADOM Member?*
- Yes
- No
- Not Sure
Practice Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is Nominee Attending the 13th Annual Dental Managers Conference?*
- Yes
- No
- Not Sure
In a 1000 words or less tell us why you are making this nomination - please provide specific examples of how the nominee has used a “green mindset” or green products in the dental practice. Nomination Letter Here*
I attest to the truth and validity of the attached statements substantiating this nomination*
- Yes

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ASCA Approved Submission Form

Thank you for joining AADOM via our Speaker/Consultant Alliance (ASCA)! We will be adding your information to our featured Speaker/Consultant page which provides exposure to our local AADOM Chapters. So that we might list your information accurately we ask that you provide the following information below: If you should have any questions or need any additional information, please contact an AADOM team member at info@dentalmanagers.com or via phone at 732.842.9977.
How would you like your name to appear?
Bio (300 words or less, you may also upload a file below)
Upload Bio (300 words or less)*
Accepted file types: word.
Upload Current High Res Head Shot*
Accepted file types: jpg.
Would you like us to link to your ADMC Bio Page or to your own website? Please provide a link to where your "contact" button should go.*
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Save My Spot for AADOM18

AADOM will be in beautiful San Antonio Texas in July of 2018. Complete the information below to share your interest in attending. An AADOM team member will reach out to you following our 2017 Conference to confirm your attendance in 2018.
Name*
First Last
Title*
Practice*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
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Save My Spot for AADOM19

AADOM will be in beautiful Orlando, Florida in July of 2019. Complete the information below to share your interest in attending. An AADOM team member will reach out to you following our 2018 Conference to confirm your attendance in 2019.
Name*
First Last
Title*
Practice*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
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Save My Spot for AADOM18 Exhibitor

AADOM will be in beautiful San Antonio Texas in July of 2018. Complete the information below to share your interest in attending. An AADOM team member will reach out to you following our 2017 Conference to confirm your attendance in 2018.
Name*
First Last
Title*
Company Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
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Save My Spot for AADOM19 Exhibitor

AADOM will be in beautiful Orlando Florida in July of 2019. Complete the information below to share your interest in attending. An AADOM team member will reach out to you following our 2018 Conference to confirm your attendance in 2019.
Name*
First Last
Title*
Company Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
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Membership Services Weekly Report

Please provide updates on this past week on hot topics, projects, industry news, etc. Help to keep the team up to date on the latest!
Date*
Name*
First Last
Highlights of my week included:*
Membership Stats
This space to be used for membership activity, webinar stats, conference numbers, etc.
New decisions made:
Industry news:
Notes About Vacation Time or Upcoming Travel
Ideas for Heather's Weekly Blog Post
Heather will be posting a blog entry on the website every week, if you have ideas for topics she should write about, please include here.

Anita Project Request

Today's Date:*
Is this a NEW project?*
Project Requester:*
First Last
Requester Department*
Project Name:*
Need by Date:*
Email
Format/Size Needed:*
Describe the purpose of the project, how will it be used, audience, etc.*
Messaging - What is project communicating in general?*
Specific desired copy - include headlines, bullet points, etc.*
Is there a specific call to action?*
Branding Type (Select all that apply)
If other please explain:
Do you have examples of imagery you would like to see included?
Drop files here or

ASCA Approved Submission

How would you like your name to appear?
Please also include any designations. Example: Jane Smith, DDS
Bio (300 words or less, you may also upload a file below)
Please provide a link to where your "contact" button should go.
You can also choose to use your ADMC "bio" page.
Upload Current Head Shot (should be 300 X 300 dpi)
Upload your bio (300 words or less)

AADOM Contractor Weekly Report

Please provide updates on this past week on hot topics, projects, industry news, etc.
Date*
Name*
First Last
Highlights of my week included:*
New decisions made:
Industry news:
Notes About Vacation Time or Upcoming Travel
Notes/Comments
Blog Topic Ideas/Suggestions for Heather
Heather is posting a weekly blog on the website and is looking for ideas for posts. If you have an idea just enter it here.

2017 AADOM Conference Scholarship Application

Please note that AADOM will choose three scholarship winners from all applications received. Help us understand why you feel you should be selected to receive a 2017 Scholarship. The application deadline is March 20, 2017. Winners will be announced on March 27, 2017.
Name*
First Last
Practice Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Tell Us Why You Should Receive an AADOM Scholarship*

Roadside/AADOM Member Special Offers + Free SEO Report

Name*
First Last
Email*
Phone
Website*
Your Choice:*
- Contact me about the AADOM Member Special Offers!
- Send my free, personalized SEO Report!
SEO Report Format:
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2017 FAADOM Inductee Survey

Name*
First Last
Cell Phone*
I have guests attending ceremony.*
- Yes
- No
How many total guests are attending?
***Please note - inductees may invite 2 guests to attend the private FAADOM lunch prior to the ceremony. Guests not attending the lunch should arrive in the Kierland Ballroom at 12:15pm.
How would you like your name to appear on your award?*
Gown Size*
- 36 Regular
- 39 Regular
- 42 Regular
- 45 Regular
- 45 Plus
- 48 Regular
- 48 Plus
- 51 Regular
- 51 Plus
- 54 Regular
- 54 Plus
- 57 Regular
- 57 Plus
- 60 Regular

Lighthouse 360 Registration

Name*
First Last
Title*
Name of Dental Practice*
Practice Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Phone*
Office Fax*
Email*
Website
Type of Practice*
If Specialized, please provide specialty.
Are you currently an AADOM member?*
- Yes
- No
- Not sure
Username for member login*
Password for member login*
Lighthouse Activation Code*
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Non Dues Revenue Team Weekly Report

Date*
Weekly Tasks Roger*
Weekly Tasks Karin*
Conference Booth Space - Sold, Bartered, Still Available*
Weekly Tasks Trish*
Weekly Tasks Lorie*
Time Off - FYI's - Special Requests
Industry Sponsor News
Blog Idea Suggestions

Dental Spouse Business Network Inquiry

I'd like more information about AADOM's Dental Spouse Business Network.
Name*
First Last
Email*
Phone*
Comments

Basic Membership

Name*
First Last
Title*
Name of Dental Practice*
Practice Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Phone*
Office Fax*
Email*
Website
Type of Practice*
If Specialized, please provide specialty.
Practice Management Software*
Basic Membership Promotional Code*

Enter to WIN a new website!

Step 1 of 2

50%

1. Your Current Website*
2. Why have you kept your ugly old website for so long?*
Other...
3. Tell us why your practice should WIN a beautiful new website!*
By entering, you accept and agree to all of the official rules.

Name*
Email*
Phone*

Observer Print Subscription

Name*
First Last
Title*
Practice Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Observer Print Subscription*
Price: $29.95 Quantity:
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Collateral Request - AADOM Team

Step 1 of 2

50%

Please complete the form below to request AADOM promotional materials to be utilized at your upcoming event! Forms must be received at least 14 days prior to the event.
Name*
First Last
Name of event*
Expected Attendance*
Date of event*
Please ship materials to:
Business (if applicable)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Attention*
First Last
Date items need to be received by:*
Do you need return shipping labels?*
- Yes
- No
Do your return shipping labels need to be for a specific shipping company, ie. Fed Ex, UPS, etc? Please specifiy below.*

Pkg-25 AADOM Membership Applications/Benefits Message
Price: $0.00 Quantity:
Pkg-25 New Member Benefits Flyer
Price: $0.00 Quantity:
Pkg-25 Foundations of Dental Practice Management Flyers
Price: $0.00 Quantity:
Pkg-25 Insurance Essentials Flyers
Price: $0.00 Quantity:
Pkg-25 FAADOM Requirements Flyer
Price: $0.00 Quantity:
Pkg-25 2017 Conference Flyer
Price: $0.00 Quantity:
Pkg-25 AADOM Mini Observer (25 Maximum)
Price: $0.00 Quantity:
Pkg-25 AADOM Presentation Folders (25 Maximum)
Price: $0.00 Quantity:
Pkg-25 ASCA Flyers
Price: $0.00 Quantity:
AADOM Tablecloth (Navy)
Price: $0.00 Quantity:
Booth Backdrop - Pipe and Drape Version w/Foxie
Price: $0.00 Quantity:
Tradeshow Booth - Pop Up Frame Version
Price: $0.00 Quantity:
AADOM Benefits Banner
Price: $0.00 Quantity:
Additional Items Needed

Enter to WIN a new website!

Only one entry per practice, please.

Step 1 of 2

50%

1. Your Current Website*
2. Why have you kept your ugly old website for so long?*
Other...
3. Tell us why your practice should WIN a beautiful new website!*
By entering, you accept and agree to all of the official rules.

Name*
Email*
Phone*

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