ADA Leadership Application

If you have any questions, please reach out to Katherine (katherine@indental.org). Council on Dental Practice and New Dentist Council positions rotate to Indiana for the upcoming term. All other positions are "at large" meaning any ADA member may apply.

Question Title

* 1. Name:

Question Title

* 2. Email:

Question Title

* 3. Please indicate which council/committee you are applying for. Please note you may not apply if you currently serve on an ADA council/committee.

Council on Dental Practice (IDA Representative)

New Dentist Council (IDA Representative)

Advisory Committee on Annual Meetings (AT LARGE)

Continuing Education Provider Recognition (AT LARGE)

Dental Accreditation (AT LARGE)

Member Insurance and Retirement Programs (AT LARGE)

Recognition of Dental Specialties and Certifying Boards (AT LARGE)

Scientific Affairs (AT LARGE)

Question Title

* 4. Please provide a brief narrative statement of qualifications as it relates to the position indicated above:

Question Title

* 5. Resume/CV (Required):

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File