Leadership Institute - Apply

   Yes, I would like to be considered for the MDS Leadership Institute. The deadline for submitting an application is May 31, 2015.  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.





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 16, 2015 1:00–5:00 p.m.
October 21, 2015 1:00–5:00 p.m.
February 10, 2016 1:00–5:00 p.m.
March 9, 2016 1:00–5:00 p.m.


Special Team-building Evening Program (location TBD)

November 18, 2015 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.


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).