House of Delegates RSVP 2021

Prefix

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Will you be attending the 2021 House of Delegates?*

Yes
No

Will your spouse/guest be accompanying you?*

Yes
No

If yes, what is your spouse/guest's name?

What is your district?*

Minneapolis District
Northeastern District
Northwestern District
Saint Paul District
Southeastern District
Southern District
Student District
West Central District
Invited Guest of the MDA

Please indicate the capacity you will be serving in the 2021 House of Delegates.*

The MDA is considering electronic voting. Will you have access to a computer or smartphone during the HOD meeting?*

Yes
No
Not applicable

Please RSVP for the following events by checking the boxes next to the events you plan to attend. Delegates and Alternate Delegates are required to attend the open forums. All other events are optional.*

Reception on Thursday, September 23, from 7 p.m. to 9 p.m.
Breakfast on Friday, September 24
Lunch on Friday, September 24

If your spouse/guest is attending, please check which events he/she will be attending.

Reception on Thursday, September 23, from 7 p.m. to 9 p.m.
Breakfast on Friday, September 24
Lunch on Friday, September 24

Do you have any dietary restrictions?*

Yes
No

If yes, please indicate dietary restrictions.

Minnesota Dental Association

House of Delegates RSVP 2021

House of Delegates RSVP 2021

HOD Online RSVP 2021