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Washington State Dental Association

2017 CITIZEN of the Year
Nomination Form

    The WSDA’s Citizen of the Year award is given to the member who has performed outstanding service, which serves to help a community in need, reinforce the value of service to the dental community, and promote the image of dentistry. The coveted award is the highest honor the association can bestow on one of its own.   
    This year, the WSDA Board of Directors voted to expand qualifying service to include work done on behalf of an employer or in a practice. Additionally, because charity begins at home, the board decided that priority would be given to dentists performing good works here in the state.
    Last year, Dr. Loree Bolin was the WSDA’s Citizen of the Year. Since 2007, the intrepid world traveler, athlete, and dentist has volunteered her services on more than 13 relief trips to Haiti, the Philippines, Honduras, Uganda, and Tanzania while with Medical Relief International (MRI), and later to Nepal and Tanzania with the Health & Hope Foundation (HHF), which she created. In Tanzania, she works with communities in the Ngorongoro Crater (Maasai) and Mwanza creating programs that bring children healthcare, education, clean water, and programs designed to help them thrive. 
    If you know someone like Dr. Bolin who has given selflessly, please nominate them for this important recognition of good work. Apply online at wsda.org/coy-nomination-form.
        This year the award will be presented at the Citizen of the Year Award banquet held during the annual House of Delegates meeting on Friday, September 15 at Skamania Lodge in Stevenson, WA. We hope you'll join us in recognizing the good works of one of your own.

 


    
    This year the award will be presented at the Citizen of the Year Award banquet held during the annual House of Delegates meeting on Friday, September 15 at Skamania Lodge in Stevenson, WA. We hope you'll join us in recognizing the good works of one of your own.

Dentists, dental team members and component society executives are now invited to nominate a WSDA member dentist for the 2017 award. The deadline for nominations is June 2. Forms and award guidelines are available from component society secretaries and executive directors, or the WSDA office.
Nominee's Name *
Nominee's Name
Nominee's Office Address
Nominee's Office Address
Special civic and charitable activities and/or accomplishments: (Please list with pertinent details and dates)
Please explain why you believe your nominee should receive this award.
Nominated By *
Nominated By
Phone *
Phone
Please check one · I am a: *