Board of Directors Application - College of Diplomates of the American Board of Pediatric Dentistry

Board of Directors Application

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Applicant Name *
Applicant Phone *
Applicant Email *
What year were you Board Certified? *
What position are you applying for? *
Have you attended a COD breakfast meeting in the last 3 years? *
Have you attended a COD Study Club in the last 3 years? * *
Have you attended a COD Webinar in the last 3 years? *
What is your practice setting? (ie. academic, private practice or public health) *
In the space below, explain why you feel you would be the best candidate to fill the available COD Board of Directors position. Please also attach your curriculum vitae below
Applicant Qualifications
CV/Biography Upload *
Optional Additional Upload

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