This book includes a plain text version that is designed for high accessibility. To use this version please follow this link.
ODA Awards Nomination


2015


Name: City:


Phone: Award Nomination for:


NOMINEE INFORMATION (Please print clearly or type.) Current Address:


State: Email:


Distinguished Dentist Service Award - A member dentist who has made a great contribution in advancing dentistry. Young Dentist of the Year - A member dentist who has been in practice ten years or less with active interest in organized dentistry and who has enhanced the image of the dental profession. Thomas Jefferson - A member dentist who has made significant contributions to community service and philanthropic works in the area of dentistry. Robert K. Wynne - A member dentist who has worked to advance the knowledge of dentistry and dental health through public education and public relations efforts. Dan E. Brannin - A member dentist who has made advancements of the principles and practice of ethics and professionalism in dentistry. Richard T. Oliver - A member dentist who has provided outstanding leadership in the Oklahoma legislative process on behalf of the Oklahoma Dental Association.


Name: City:


Phone:


NOMINATED BY (Nominations must be made by an ODA Member Dentist. Self nominations are accepted.) Current Address:


State: Email: BRIEFLY DESCRIBE WHY HE/SHE DESERVES THE AWARD Zip: Zip:


A letter of nomination MUST accompany each nomination describing the nominee’s accomplishments and other contributions to the dental profession. Additional letters of recommendation, résumés and other documents are encouraged. Use a separate form for each award nomination. Copies of this original form will be accepted.


Signature: Submit by mail:


Oklahoma Dental Association Attention: ODA Annual Awards, 317 NE 13th Street Oklahoma City, OK 73104 by fax: 405.848.8875


December 2014 www.okda.org 15 Date:


Don’t Forget!


Deadline for nominations is December 31, 2014!


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44