LDC	Volunteer Leadership Application

CSPD Leadership Recruitment and Potential Leaders Databank

CSPD is a volunteer led organization in constant need for enthusiastic volunteers to continue its forward leadership momentum and positive growth. In this regard, the Leadership Development Committee is actively recruiting and identifying potential candidates for leadership positions on Committees and the Board. Please complete this form to indicate your willingness to volunteer for leadership opportunities.

All applications are due by November 10th, end of business day.

This electronic form will be sent to: Dr. Santos Cortez
3320 Los Coyotes Diag., Ste. 200
Long Beach, CA 90808
Phone: (562) 377-1375
email: LDC@cspd.org

Personal Information

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Name
Mailing Address
Email Address
Office Telephone
Cell Telephone
Home Phone
Committee Preferences Please indicate which Committee(s) (up to three) in which you have interest in serving. A listing and description of CSPD's Committees can be reviewed on CSPD's Committees & Descriptions.
First Choice
Second Choice
Third Choice
Reasons for Serving Please state briefly your reason for your interest in serving on the committee(s) and cite any expertise, skills, and leadership experiences that you will bring to the committee(s).
Curriculum Vitae Please attach a synopsis of your curriculum vitae in which includes the three most recent and pertinent leadership positions such as officer, committee or board member, that you have held in any organization within or outside of dentistry.