: CDHA

Membership Type
Basic Information
Demographic Information
Subscriptions & Donations
Totals

Membership Type

Supporting Member Dues

Professional Member Dues

New Professional Member Dues

Senior Member Dues

Student Member Dues

Second Year Student Member Dues

- I am not currently employed in a dental hygiene-related career.

- I will contact CDHA to change my membership type to Professional if/when I begin working in the dental hygiene field again.

- I understand that this membership type is not eligible to serve as a delegate, hold office, or vote within CDHA.

Demographic Information

Preferred Mailing Address

Address Type

Address

Address Cont.

Zip

City

State

Component

Preferred Phone

Do you wish to be excluded from the Member Directory?

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Demographic Information

Date of Birth (mm/dd/yyyy)

Dental Hygiene School Attended

Date of Graduation (mm/dd/yyyy)

Professional Information

Dental Hygiene License Number Click here to look up your license number and issue date.

Initial RDH Licensure Issue Date (mm/dd/yyyy) Click here to look up your license number and issue date.

I am an RDHAP

Chapter Name	Amount
Central Coast Component Dues	$30.00
Delta Pacific Component Dues	$30.00
East Bay Component Dues	$30.00
Kern County Component Dues	$30.00
Long Beach Component Dues	$30.00
Los Angeles Component Dues	$30.00
Monterey Component Dues	$30.00
Mt. Diablo Component Dues	$30.00
Napa-Solano Component Dues	$30.00
Orange County Component Dues	$30.00
Out-of-State	$0.00
Peninsula Component Dues	$30.00
Redwood Component Dues	$30.00
Sacramento Valley Component Dues	$30.00
San Diego Component Dues	$30.00
San Fernando Component Dues	$30.00
San Francisco Component Dues	$30.00
San Gabriel Valley Component Dues	$30.00
San Joaquin Valley Component Dues	$30.00
Santa Barbara Component Dues	$30.00
Santa Clara Valley Component Dues	$30.00
Shasta Component Dues	$30.00
Six Rivers Component Dues	$30.00
South Bay Component Dues	$30.00
Tri-County Component Dues	$30.00
Valley Oaks Component Dues	$30.00
Ventura Component Dues	$30.00

Totals

Payment Options

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There is a 2% surcharge on credit card transactions to cover merchant fees.

Accepted Card Types

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Expiration Date

Expiration Year

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Enroll into the EZPay program for automatic renewal

CDHA memberships, with the exception of students, are enrolled in EZPay and will automatically renew yearly on your anniversary date. Professional members have the option to renew quarterly with a $5 convenience fee added to each quarter's dues. To opt out of automatic renewal and receive an annual membership dues invoice electronically, toggle the option above labeled Enroll into the EZPay program for automatic renewal so that it is unmarked. For additional questions please email memberservices@cdha.org.

Billing Information

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First Name

Last Name

Billing Address

City

State

Zip

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I accept the Code of Conduct & Terms of Use

Membership Dues

$0.00

Component Dues

$0.00

Taxes

$0.00

Total

$0.00

Membership Application

Membership Type

Basic Information

Demographic Information

Preferred Mailing Address

Demographic Information

Professional Information

Optional Chapters

Subscriptions & Donations

Totals