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THE INTERNATIONAL ASSOCIATION
OF STUDENT CLINICIANS -
AMERICAN DENTAL ASSOCIATION

BALLOT

Election of Officers and an Elective Member of the Board. The Associate voting must put a check mark (x) before the name of the chosen nominees.
NOMINEES
PRESIDENT Gareth R. Brock, B.D.S., Ph.D.
VICE PRESIDENT Joel H. Berg, D.D.S., M.S.
ELECTIVE MEMBER
OF THE BOARD

Jane C. Puskas, D.M.D., M.P.H.
WRITE-IN CANDIDATE
POSITION NAME

Please enter the following information to confirm your ballot:

Name:   
Address:   
 

  

 
 
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