Submit Your Classified Ad

Ad Submission & Payment

Thank you for advertising with the Kansas Dental Association!

Please complete the form below, and a KDA staff member will contact you via email within 2 business days along with an invoice and card authorization form should you choose to do recurring payments.

Your ad will be posted after payment is received.

The invoices will be sent via email only so please make sure your email is inputted correctly.

Please direct questions to Sandra Romero, KDA Communications Coordinator.

Contact Information

Do you currently have an ad posted with us?

Yes
No

Are you a member of the Kansas Dental Association?

Yes
No

You do not have to be a KDA member to advertise with us. However, your ad must pertain to dentistry in the state of Kansas.

Title:

First Name:

Last Name:

Phone:

Email:

Billing Address

Street Address

City

State

Zip

Name of Practice/Company:

Recurring Payment Form

If you wish to enter into recurring payment, please download and complete the form below to authorize recurring payments. Upon completion, upload form or email it to melissa@ksdental.org.

Recurring Payment Authorization Form

Completed Recurring Payment Form

Advertisement Information

Are you okay with your ad appearing on our social media outlets? Note: The social media post will only be up for as long as you are invoiced for.

Yes
No

Duration of Ad Placement:

1 month, 6 months, until further notice, etc.

Ad Category:

Title of Advertisement:

ex: Seeking Associate Dentist - Topeka, KS

Advertisement Text:

Please note that ads containing more than 125 words may be assessed an additional fee of $25. Please specify location.

Who should the applicant contact? (If different from above)

Name, email, number

Photo(s):

Please note that including a photo with your ad costs an additional $25 per month.

Ad Submission & Payment

Contact Information

Billing Address

Recurring Payment Form

Advertisement Information

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