2024 ODA AWARDS NOMINATION DEADLINE FOR NOMINATIONS IS DECEMBER 31, 2023
Nominee Information (Please print clearly or type) Name:
Address:
City:
State:
Phone:
Email:
Zip:
Award Nomination (please check one) Richard T. Haught Dentist of the Year - A member dentist who has made a great contribution in advancing dentistry.
Young Dentist Award - A member dentist who has been in practice ten years or less with active interest in organized dentistry and who has enhanced the image of the dental profession.
Thomas Jefferson Citizenship Award - A member dentist who has made significant contributions to community service and philanthropic works in the area of dentistry.
Robert K. Wynne Memorial Award for Public Education and Public Information - A member dentist who has worked to advance the knowledge of dentistry and dental health through public education and public relations efforts.
Dan E. Brannin Professionalism Award - A member dentist who has made significant contributions to the advancements of the principles and practice of ethics and professionalism in dentistry.
Richard T. Oliver Award for Legislative Leadership - A member dentist who has provided
outstanding leadership in the Oklahoma legislative process on behalf of the Oklahoma Dental Association.
NOMINATED BY (Nominations must be made by an ODA Member Dentist. Self nominations are accepted.) Name:
Address:
City:
State:
Phone:
Email:
Zip:
A letter of nomination MUST accompany each nomination describing the nominee’s accomplishments and other contributions to the dental profession. Additional letters of recommendation, résumés and other documents are encouraged. Use a separate form for each award nomination. Copies of this original form will be accepted. Signature: Submit by mail: Oklahoma Dental Association Attention: ODA Annual Awards 317 NE 13th Street Oklahoma City, OK 73104
Date: By fax: 405.848.8873 By email: kfaherty@okda.org
Deadline for nominations is December 31, 2023 www.okda.org
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