AADA Leadership Opportunity Form

Please fill out the form below if you are interested in holding a leadership position on AADA's Leadership Council or an Advisory Position.

Be sure to review the position descriptions that were sent to you to familiarize yourself with the responsibilities of each role.

YOUR CONTACT INFORMATION

FIRST NAME:

LAST NAME:

EMAIL:

PHONE NUMBER:

INTERESTS

Select the top three areas that interest you the most from the drop down below.

1st CHOICE:

2nd CHOICE:

3rd CHOICE:

I am interested in holding the following positions (select all that apply)

Leadership Council:

President President-Elect Treasurer Member

Advisory Councils:

American Dental Political Action Committee (ADPAC) Representative Council on Advocacy for Access and Prevention (CAAP) Representative Council on Government Affairs (CGA) Representative Dental Health Education (DHE) Coordinator Meeting Coordinator Surviving Spouse Liaison Student Spouse Liaison Well-Being Coordinator