Nomination Form for Officers/Trustees

Candidates for office may be nominated by any active, life, or special member of the ADAA, a Local or State Organization, or a trustee district. The top portion of this form shall be complete and signed by the member or organization nominating the candidate. Sign as organization only if the organization has voted to nominate the candidate.  The bottom portion of this page shall be completed and signed by the candidate.  If multiple forms are submitted, the first one submitted will be the one printed in the Delegate’s handbook.

INCOMPLETE FORMS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE NOMINEE.

Address:
Address:

Nomination forms must be received by ADAA Central Office no later than June 30th of the election year.  Forms may be mailed or sent via email attachment (electronic signatures are acceptable).  

INCOMPLETE FORMS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE NOMINEE.

 

Please attach a one-page position statement for inclusion in the Delegates’ Handbook SEPARATELY

A 2-minute oral presentation to the delegates will be given following the First House of Delegates.  Please also submit a black and white photograph for publication in the official Annual Session Program. 

I hereby state that the information contained hereon is true and, if elected to the above-mentioned office, I shall uphold and support the policies of the American Dental Assistants Association.  I will accept the responsibilities of that office and shall serve to the best of my ability and agree to attend the Installation, New Officer/Trustee Orientation and Post-Annual Session Board of Trustees meeting.  I understand that I must be able to communicate on a regular basis via email.

 

BEFORE CLICKING SUBMIT, VIEW THE FOLLOWING INFORMATION:

Verify use of proper grammar, ADAA will not change the format of the form

Do not use ALL CAPS, do not use all lower case

REMEMBER to submit additional documentation separately

You will receive a confirmation that your submission has been received