Guest Board Membership Application

MDS Board and Staff

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Officers, Trustees, and Staff of the Massachusetts Dental Society.

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Guest Board Member Application                  print this page

To apply for the Guest Board Member Program, please complete the information below and then submit a CV to the MDS. The Guest Board Member Program is open each year to four dentists from the categories listed below, and one Guest Board position is reserved for a dentist from the Boston Collaborative Group.

  • Two women dentists
  • One Non-Caucasian dentist
  • One new dentist (less than ten years in practice) or a dentists who is new to MDS leadership.

Full Name:

District:

Phone:

Email:

 

Please tell us why you would like to be selected for the MDS Guest Board Member Program:

 

What volunteer activities or leadership programs have you participated in with the MDS, your local component district society, or the American Dental Association?

 

Have you participated in any other leadership training programs?