Sponsor Nomination for New Fellows

Fellowship Application

Gold Medal Award Nomination Form

Elmer S. Best Memorial Award Nomination

Model Section Award Application

Section Distinguished Dentist Award Nomination Form

Special Appreciation Award

Outgoing Section Chair Plaque

About the Forms

We have provided three options for form submission (web, pdf or print). If you would like to use the pdf to submit your nomination, please open the form in Acrobat Reader as some features may not work correctly in some browsers. If you would like to print the pdf and mail the nomination, please use the address below.

Please note: All submitted forms will be sent to the PFA international headquarters for review. We will send you an email conformation when we receive the completed form.

Mailing Address

Pierre Fauchard Academy
103 North Adams Street
Rockville MD, 20850
U. S. A.

Contact Us

Phone: +1 240-658-8070
FAX: +1 240-266-9188
Email: executivedirector@fauchard.org