Officer Form


	Michigan Dental Assistants Association P. O. Box 118 Lennon, MI 48449

Officer Nomination Form

NOTE: Form is under construction; please print and snail mail to addresses below or copy, paste and email to Karen and Gwen


Nominee
Credentials Email
Street	City & Zip
Phone	Work Phone
ADAA Membership Number
Name of Local
MDAA position applying for
Please list any officer or committee position held at the local, state, or national level and the year
Please list nominee qualifications pertaining to the position desired

Deadline to submit this form or mail a copy is March 1, 2010 to both:

Karen Minca CDPMA	Gwen Graham-Feldkamp CDA, R.D.A.
MDAA Nominating Chairperson	MDAA Secretary
3477 Ridgecliff Drive	2121 Baker Road
Flint, MI 48532	Dexter, MI 48130

Qualifications to be nominated as a MDAA Officer or Committee Chairperson:

All candidates must be active, active student 1, 2, 3, life, or special member of MDAA
Must be a MDAA member is good standing
Must have an interest in the Association and a willingness to learn & perform the duties of the position
Must have a copy of current membership card or proof of paid dues