2019 ODA Dental Day Student Registration

Thank you for joining us on Tuesday, February 26 for the 2019 ODA Dental Day at the Capitol- we look forward to seeing you in Salem!

We will start the day with an orientation, and then you will have the chance to meet with your legislators, educating them about the importance of oral health.

Please note that by registering, you agree that photographs of you taken at the event may be used in ODA materials and publications.

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* 1. Name

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* 2. Email

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* 3. Cell/Day-of Phone Number

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* 4. Will you be utilizing ODA transportation to and from Salem?

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* 5. In order to best match attendees to their individual legislators, please provide your current address.

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* 6. In order to best match attendees to their individual legislators, please provide your home address.

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* 7. Please indicate any personal connections you may have to a legislator.

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* 8. ODA will have a dental chair open in the Capitol Galleria, to offer free screenings to legislators.  Are you interested in volunteering at the dental chair for a portion of the day?

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* 9. Do you have any dietary restrictions? 

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