Illinois State Dental Society

 

 
 
 
 
 

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Home > Laws and Legislation > DENT-IL-PAC > DENT-IL-PAC Contact Dentist Form

Become a contact Dentist

Contact Dentist – An individual who is committed to the advancement of ISDS issues and who serves as a liaison to Illinois’ elected policymakers.

The Illinois State Dental Society needs individuals to serve as key contacts to Illinois’ State Officials.  Do you know the Governor, Lieutenant Governor, or a State Legislator?  If so, let us know!

In the effort to increase ISDS's contact database and to build strength at the grassroots level, please list those elected officials to whom you could serve as a Key Contact.  A strong grassroots organization will help to ensure the dental profession a voice in government.

Key Contact Information
Name:
Email:
Office Phone:
Office Fax:
Home Address:
City:  State: Zip:
Legislator's Name:
Relationship: Friend   Neighbor
  Relative  
  Other    
 

Please complete this form in its entirety. It will be submitted to:

Government Relations Department
Illinois State Dental Society
1010 S. Second St. Springfield, IL 62704
 
Illinois State Dental Society P.O. Box 376 Springfield, IL 62705 (217) 525-1406
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