1. Your name

2. In which ZIP code is your residence located?

3. Please list names of legislators you can contact

4. Dental Day at the Legislature is Friday, January 27. Briefing on issues over breakfast at 7:30 a.m. Meet with legislators during the day. Dentist Advocates luncheon. Hosted Reception and Dinner for legislators and dentists at 6 p.m. Please tell us if you will participate and which events you will attend.

5. Please share your comments on dental or other legislative issues that are important to you.