Volunteer Interest Form

Who Are You?

Name:

Email Address:

Phone:

Local Society:

What Are Your Interests?

(Check all that apply.)

Type of Involvement You Prefer?

(Check all that apply.)

One-Time Commitment

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.

Recurring Short-Term Commitment

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

Ongoing Commitment

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.)

MDA

Local Component

MDA Foundation

Michigan Donated Dental Services

Michigan Mission of Mercy

MDA Insurance & Financial Group

MDA Dental PAC

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

Questions?

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

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