insignia

Michigan Dental Assistants Association

P. O. Box 118

Lennon, MI 48449

Nomination for Delegate to 2012 ADAA Annual Conference

Deadline to submit this form is March 1, 2011y

NOTE: Please highlight the following form, copy and paste to email when you hit submit button.

I agree that my name be submitted for election as a delegate and understand the responsibilities involved.

Delegate Application
Name
Creditials
Address
City, State & Zip
Phone (home) Phone (office)
Local
Are you Certified? Yes No Certification Number

 

Submit Copy of Form to both:

Becky Levi
Gwen Graham-Feldkamp CDA, R.D.A.
MDAA Nominating Chairperson
MDAA Secretary
2121 Baker Road
Dexter, MI 48130

Rule 8: Any member being nominated or elected as a delegate to the ADAA Annual Conference must be present in the House of Delegates at the MDAA Annual Session. Succession of Delegates involved with tie votes shall be determined by lot before the adjournment of that House of Delegates.

Rule 9: All delegates and alternates must attend all meetings scheduled to prepare for the ADAA Annual Conference or forfeit their privilege of representing MDAA, the only exception being an excused absence given by the President due to an emergency. If a delegate/alternate does not commit to attend ADAA Annual Conference at least two (2) weeks prior to the pre-registration deadline date, they will forfeit their position and be placed at the end of the list regardless of plurality vote. Resignations should be submitted in writing to the President.

Qualifications to be nominated as a delegate to the ADAA Annual Conference