Application

Apply for a dentist to provide a dental education talk for Dental Health Week

We will endeavour to assist in finding an ADA Member dentist to volunteer to provide a dental education talk at your organisation or institution as part of Dental Health Week.

Please fill out the form thoroughly. The more information you provide helps us to find a volunteer and for them to prepare.

Apply now

Name

Email

Contact number

Are you the contact person for this event?

Yes No

If No, please fill the contact person details

Optional

Name of organisation/institution

Address

Optional

Number of people to be present at the presentation

Average age of the audience

Are your date and time flexible?

yes

Is there a specific topic you wish for the dentist to discuss?

If you are an educator, does this talk align with a unit of education?

What facilities are available to the dentist providing a

Yes, I give permission to store and process my data

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