Volunteer Interest Form - Michigan Dental Association

Who Are You?
Name
First Last
Email*
Phone
Local Society
What Are Your Interests?
What Are Your Interests?
(Check all that apply.)
- Access to Care
- Charitable Care
- Communications
- Continuing Ed.
- Dental Benefits / Insurance
- Dental Practice
- Dental Students
- Ethics
- Finances
- Foundation
- Governance
- Grant Writing
- Health & Well-Being
- Insurance Products
- Inter-Professional Relations
- Leadership Development
- Legislation
- Membership
- Mentoring
- New Dentists
- Peer Review
- Prevention
- Public Relations
- Public Speaking
- Research / Science
- Social Media
- Special Needs Patients
- Study Clubs
- Writing
Type of Involvement You Prefer?
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?
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.

MDA Member Dentist Volunteer Interest Form

Who Are You?

What Are Your Interests?

Type of Involvement You Prefer?

Where Are You Interested in Volunteering?

Questions?

Leadership Central