Leadership Institute - Apply

Massachusetts Dental Society

Two Willow Street
Suite 200
Southborough, MA 01745

(800) 342-8747
(508) 480-0002 fax

Officers and Trustees

Directions to the MDS Headquarters

The MDS is located conveniently off exit 12 of the Mass Pike (I-90).

Directions
 

   Yes, I would like to be considered for the MDS Leadership Institute. The deadline for submitting an application is May 31, 2014.  A limited number of positions are available each year. Applications are reviewed and final selections are made by the MDS Membership Committee.

This application is also available to download as a PDF form.

Name:

Phone:

Email: 

 

What do you hope to achieve from the MDS Leadership Institute Program?

 

What prior volunteer roles/activities have you been involved with? (Please list dental and community.)

 

Submit CV: Please submit your CV by email (membership@massdental.org), fax (508-480-0002) or mail (Two Willow Street, Suite 200, Southborough, MA 01745)

 

  I understand that I am agreeing to attend:

 

Four half-day Wednesday Meetings will be held at the MDS Headquarters in Southborough.

September 10, 2014 1:00–5:00 p.m.
October 22, 2014 1:00–5:00 p.m.
February 11, 2015 1:00–5:00 p.m.
March 11, 2015 1:00–5:00 p.m.

 

Special Team-building Evening Program (location TBD)

November 19, 2014 6:00–9:00 p.m.

 

Upon completion of the first year, participants will be required to serve on a special Ad Hoc Committee. You will have the opportunity to decide on the committee’s focus and its effects on the profession. There will be a kick-off meeting held at the MDS Headquarters in Southborough.

April 15, 2015 6:00–8:00 p.m.