Student Chair Application

University of Illinois at Chicago College of Dentistry & Southern Illinois University School of Dental Medicine. Deadline: November 1, 2008

Member ID:

 

First name:

Last name:

 

Address:

 

City:

State:

Zip code:

 

Phone:

 

E-mail:

 

Class level:

• Sophmore
• Junior
• Senior

 

Dental School:

• UIC
• SIU

 

Availability:

• Two half days
• One full day

 

Volunteer Dates:

• Thursday February 26, 2009
• Friday February 27, 2009
• Saturday February 28, 2009
• Sunday March 1, 2009

 

Subjects of Interest:

 

I agree to provide a personal signature on site at McCormick Place Lakeside Center, Room E251, in order to allow CDS to process my per diem check:

 

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