MINDENPAC Board Application

Name*

First Last

Email*

Dental Specialty*

Clinic Name*

Clinic Location*

Street Address Address Line 2 City State ZIP Code

District Dental Society*

Why are you interested in joining the MINDENPAC Board?*

The primary funding source for MINDENPAC is through the dues renewal process when members voluntarily contribute to the PAC. The Board has recently discussed other ways to fundraise for the PAC. Do you have any ideas on creative ways to help the PAC raise more money?