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Volunteer Interest Form

Who Are You?

What Are Your Interests?

(Check all that apply.)

Type of Involvement You Prefer?

(Check all that apply.)

Examples: Attend an in-district meeting with a legislator, write a Journal or newsletter article, serve as a host at a CE meeting, review a new MDA member resource, be a Mission of Mercy volunteer.

Examples: Participate in a work group or think tank, be a spokesperson for community water fluoridation in your area.

Examples: Serve on an MDA committee, the Board of Trustees, or on a committee or board for a related organization.

Where Are You Interested in Volunteering?

(Check all that apply.)

Have specific ideas on how you'd like to get involved? Tell us here!


Contact Jennifer Lennemann, executive assistant, at 517-346-9461.