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