Michigan Dental Assistants Association
NELLIE GRAVES EDUCATION AWARD
REGISTRATION FORM
SCHOOL REPRESENTING: _____________________________________________________
PRESENTER: _________________________________________________________________
TOPIC: _______________________________________________________________________
DENTAL INSTRUCTOR AND PHONE: __________________________________________
__________________________________________
MDAA will supply a podium and microphone. If any additional audiovisual equipment is needed, please contact the Student Day Chairman to discuss availability.
Please return completed form no later than: April 4, 2012
Mail or email to:
Gwen Graham-Feldkamp
MDAA Student Day Chairman
2121 Baker Road
Dexter, MI 48130
grahamgagf@comcast.net
(Reviewed 2005, File# AUT0101)