TDA Legislative Contact Dentist Form
The TDA is seeking member dentists interested in playing an active role in government relations. Contact dentists may already have existing relationships with individual lawmakers, or may be willing to connect with their legislator on behalf of the TDA. As a contact dentist, you will be called upon to help educate and engage with lawmakers on issues impacting the dental profession.
First Name
*
Last Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ADA #
Local Society
*
Please Select
First District
Knoxville Area Dental Association
Chattanooga Area Dental Society
Fourth District
Nashville Dental Society
Sixth District
Seventh District
Eighth District
Memphis Dental Society
Are you willing to connect with legislators representing your district?
*
Yes
No
Do you have existing relationships with any Tennessee lawmakers? If so, please list their name(s) and any helpful context.
Submit
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