Student Chair Form

D3 and D4 dental students from the dental colleges of UIC, Midwestern University and SIU are invited to serve as Room Chairs for the Midwinter Meeting.

You will receive a $200 honorarium, breakfast and lunch and CE credit for serving the whole day.

You must be a CDS member (Dental Students join for free) and be registered for the Midwinter Meeting.

Complete the application below.

CDS Member Number

Prefix

Dr.

Mr.

Ms.

First Name

Last Name

Address 1

Address 2

City

State

Zip

Phone Number

Email Address

Class

Dental School

Volunteer Dates

Thursday, Feb. 23, 2023

Friday, Feb. 24, 2023

Saturday, Feb. 25, 2023

I agree to provide a personal signature in order to allow CDS to process my per diem check

I agree