Michigan Dental Assistants Association

P. O. Box 118

Lennon, MI 48449

Officer Nomination Form

Due by March 1, 2017

NOTE: Please complete, print, and snail mail to Paula and Deborah

NOTE: You may nominate yourself or be nominated by another member.

City & Zip
Work Phone
Name of Local

Please list officer/committee position(s) held at the local, state, or national level & the year



Deborah Jaruzel


MDAA Secretary
MDAA President-Elect