Ohio EFDA Association Membership Form

Membership Type

$45 - 2022 Membership

$25 - 2022 Student

Select All that apply

Select one

New MemberRenewing member

Select if YES

I am willing to be a mentor to a new EFDA

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Full Name

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

In Memory Of:

Honoree Name:

Send Email acknowledgement to:

Send Postal Mail acknowledgement:

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Dedication Message:

Payment Details

Credit Card eCheck

Routing Number: *

Account Number: *

Check Number: *

Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

You will be charged:

Secured and Powered by Click&Pledge

The only voice EFDAs have. Join today!

Whether you are an EFDA, an EFDA student, or a dentist, membership in the Ohio EFDA Association brings you a growing list of benefits:

• Being informed of the constant changes to our profession

• Having a voice in Ohio public policy

• Members only access to advocacy updates.

• Continuing restorative education at little or no cost

• Notification and discounts on CEU courses

• Members only access to job information

• Mentoring service for practicing EFDAs and EFDA students

• Exclusive vendor discounts from hundreds of vendors nationwide

The Ohio EFDA Association speaks for Ohio EFDAs at the Ohio Dental Summit, Ohio Dental Workforce Roundtable, Ohio State Dental Board meetings, and the Ohio Dental Association Annual Session among other dental meetings across the state.

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount