Apply for WSDA/ADA Elected Positions

The following WSDA and ADA elected positions are up for election at the 2020 House of Delegates in September:

President-elect (1 position)
Board of Directors (4 positions)
Delegate to the ADA (3 positions)

Expand below to learn more and see requirements for each position, and fill out the form on this page to apply.

Application Deadline: June 30, 2020

Position Details
President-elect (1 position)
- Term: 1 year as President-elect, 1 year as President, 1 year as Immediate Past President, 3 years as ADA Delegate (2021, 2022, 2023)
- Requirements: WSDA member. Must have been a member for the preceding five consecutive years.
Board of Directors (4 positions)
- Term: 3 years
- Requirement: WSDA member
Delegate to the ADA (3 positions)
- Term: 3 years (2021, 2022, 2023)
- Requirement: WSDA member. Per WSDA bylaws, every three years, one delegate position will be reserved for a person who has never been elected to the ADA House and has previously served at least one year as a WSDA-appointed alternate delegate, ASDA delegate, or alternate delegate to the ADA House.

Application

Personal Information

First Name

Last Name

ADA Number

Email Address

Address

Home or office address?

Home
Office

Phone Number

Cell, office, or home phone?

Cell
Office
Home

Do you have a Board Certified specialty?

Yes
No

If so, list specialty.

Current Positions (Limit 5)

List organization, position, and years served for up to 5 current positions.

Former Positions (Limit 5)

List organization, position, and years served for up to 5 former positions.

Professional Affiliations (Limit 5)

List up to 5 professional affiliations.

Education

List degree, university and year earned for degrees held.

Other (Limit 5)

List organization, position, and years served for up to 5 additional affiliations.

Office & Candidate Statement

Select the office you will be running for.

Include your candidate statement. Limit 250 words.

Candidate Photo

Please upload a high-quality headshot.

Conflict of Interest

Applicants must read WSDA's Conflict of Interest Policy prior to submission.

WSDA Conflict of Interest Policy

I have read and understand WSDA’s Conflict of Interest policy as stated in Bylaws IV.I (4.I) and Standing Rule 4.4.

Yes, I have read and understand the policy