NJDA Governance Restructuring Virtual Town Hall Interest Form

NJDA is planning a virtual town hall to gather member and leader perspectives on the future of the Association, including member engagement, leadership pathways, representation, and governance.

Please complete this brief form by Friday, October 2 if you are interested in participating.

Question Title

1. Are you interested in participating in the Governance Restructuring Virtual Town Hall?

Yes, I am interested in participating.

Maybe, please send me more information.

Question Title

2. Please provide your name.

Question Title

3. Please provide your email address.

Question Title

4. Which best describes your current NJDA involvement? Select all that apply.

Current NJDA leader

Current NJDF leader

Component leader

Committee, council, or task force member

New dentist / early-career member

Student or resident

General member

Other (please specify)

Question Title

5. What topics are you most interested in discussing? Select all that apply.

Representation and member voice

Board and House of Delegates structure

Councils, committees, and task forces

Component role and structure

Leadership pathways and succession

Volunteer participation and accessibility

Decision-making and governance effectiveness

How NJDA governance should evolve for today’s and tomorrow’s dentists

Other (please specify)

NJDA Governance Restructuring Virtual Town Hall Interest Form

Question Title

1. Are you interested in participating in the Governance Restructuring Virtual Town Hall?

Question Title

2. Please provide your name.

Question Title

3. Please provide your email address.

Question Title

4. Which best describes your current NJDA involvement? Select all that apply.

Question Title

5. What topics are you most interested in discussing? Select all that apply.

Question Title

6. Is there anything specific you would like NJDA to consider as part of the governance restructuring discussion?

Question Title

7. Are there any dates or times that generally work best for you to attend a virtual town hall?

NJDA Governance Restructuring Virtual Town Hall Interest Form

Question Title

* 1. Are you interested in participating in the Governance Restructuring Virtual Town Hall?

Question Title

* 2. Please provide your name.

Question Title

* 3. Please provide your email address.

Question Title

* 4. Which best describes your current NJDA involvement? Select all that apply.

Question Title

* 5. What topics are you most interested in discussing? Select all that apply.

Question Title

* 6. Is there anything specific you would like NJDA to consider as part of the governance restructuring discussion?

Question Title

* 7. Are there any dates or times that generally work best for you to attend a virtual town hall?

1. Are you interested in participating in the Governance Restructuring Virtual Town Hall?

2. Please provide your name.

3. Please provide your email address.

4. Which best describes your current NJDA involvement? Select all that apply.

5. What topics are you most interested in discussing? Select all that apply.

6. Is there anything specific you would like NJDA to consider as part of the governance restructuring discussion?

7. Are there any dates or times that generally work best for you to attend a virtual town hall?