Dental Health Week Volunteer Request Form – Educators:

Dental Health Week is a fantastic opportunity to promote oral health education in your local community. This year's theme is 18-25 years, focusing on key dental issues in this age group, including wisdom teeth, sport and cosmetic dentistry.

The ADA has created a platform where community groups can request an ADA member dentist to deliver an educational talk.

If you would like a member to visit your organisation/institution, please register your interest by completing this form.

Name *

Phone *

Other - Contact Person

Email *

Address *

Name of organisation/institution: *

Organisation Institution Address: *

Number of people attending the presentation: *

Desired date and time of presentation: *

Average age of attendees: *

Is there a specific topic you want us 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 talk (to assist in planning)? *

Dental Health Week Educator Volunteer Request Form

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