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:

PresidentPresident-ElectTreasurerMember

Advisory Councils:

American Dental Political Action Committee (ADPAC) RepresentativeCouncil on Advocacy for Access and Prevention (CAAP) RepresentativeCouncil on Government Affairs (CGA) RepresentativeDental Health Education (DHE) CoordinatorMeeting CoordinatorSurviving Spouse LiaisonStudent Spouse LiaisonWell-Being Coordinator