This survey is designed for CSDA members and dental students who may be interested in volunteering to serve on our councils, committees and task forces. Rather than listing specific groups that you may not be familiar with, this survey is designed to identify your skills and interests in order to match you with the council, committee or task force that is engaged in those activities.

The information we collect will be passed along to the Board of Governors for consideration when they make their nominations and appointments to these groups. If you have any questions, please contact Jesse Dennehy at (860) 378-1800 Ext 207 or

* 1. Have you ever thought about being involved (or becoming more involved) in the CSDA?

* 2. Which type of volunteer activities interst you? (mark all that apply)

* 3. Each of the following activities are volunteer opportunities available at the CSDA. Please let us know which of the following activities interests you; and, whether you have experience with any of the activities.

  I am interested in this activity I have experience in this activity
Connecticut State politics
Testify at Legislative Hearings
Speak with elected officials on pending legislation
Marketing/communications for members and the public
Access to Care Issues including workforce and elder care
Identifying Continuing Education Speakers for all dental professionals
Meeting logistics and hosting speakers
Identifying and interacting with potential sponsors and exhibitors
Developing themes and planning social events
Investments and financial planning
Helping patients and dentists resolve disputes
Identifying businesses to provide member discounts or other benefits
Planning for the future
Working collaboratively with other health care providers
Encouraging women to become actively involved in organized dentistry
Developing programs for dentists at any stage in their careers (e.g., new dentists, retiring dentists, etc.)

* 4. Are you interested in being contacted for possible participation on a CSDA working group (e.g., council/committee/task force)?

* 5. Name

* 6. Email address for CSDA Staff to contact you