Skip to content
Greek Leadership Nomination
1.
Your Full Name:
2.
Your e-mail address:
3.
Your component
4.
Person's full name which you are nominating:
5.
The nominee must be a member of the Illinois State Dental Society. Are they a member?
Yes
No
6.
Nominee's Full Address
7.
Year nominee entered practice:
8.
Your essay detailing examples of the nominee’s leadership qualities, community service, and involvement in organized dentistry.
9.
The nominating component/branch or individual must provide a copy of the nominee’s curriculum vitae. Please attach that here.
Choose File
No file chosen
