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’ Bios

	NOMINEES:
PRESIDENT	Tetsu Okumura, D.D.S., Ph.D.
VICE PRESIDENT	Jane C. Puskas, D.M.D., P.C.
ELECTIVE MEMBER OF THE BOARD	Sharon Gordon D.D.S., M.P.H., Ph.D.
WRITE-IN CANDIDATE
POSITION
NAME
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NAME
ADDRESS