Annual Diplomate Fee Renewal Renewal - American Dental Board of Anesthesiology Name * Credentials * Home Address * Office Address * Email Address * Work Phone * Cell Phone * Fax Phone The ADBA Board of Directors would like to list your name to the ADBA website as a Diplomate. The listing would include your name, office phone number, state you are practicing in and email. * Yes please list my name on the ADBA website No do not list my name on the ADBA website If you are human, leave this field blank. Please Note The ADBA accepts only VISA and MasterCard.