Nellie Graves Award

Michigan Dental Assistants Association

 

NELLIE GRAVES EDUCATION AWARD

REGISTRATION FORM

 

 

SCHOOL REPRESENTING: _____________________________________________________

 

PRESENTER: _________________________________________________________________

 

TOPIC: _______________________________________________________________________

 

DENTAL INSTRUCTOR AND PHONE:   __________________________________________        

 

                                                                      __________________________________________

 

MDAA will supply a podium and microphone.  If any additional audiovisual equipment is needed, please contact the Student Day Chairman to discuss availability.

 

Please return completed form no later than: April 4, 2012

 

 

Mail or email to:

 

Gwen Graham-Feldkamp 

MDAA Student Day Chairman

2121 Baker Road

Dexter, MI 48130 

grahamgagf@comcast.net                                                                                                     

  

(Reviewed 2005, File# AUT0101)