The Academy of General Dentistry (AGD) offers constituent the opportunity to request a member of the AGD Executive Committee (preferably the AGD Vice President) or the Trustees to come to your constituent program or event to discuss the AGD, promote AGD Annual Meetings, or topics designated by the constituent. It is recommended the AGD Vice President be requested since they are the liaison to the Regional Directors and gives the Vice President the opportunity to share his or her vision for the organization early in office. Requesting the Vice President will help manage the travel demands of the President.

If your constituent is interested in having an AGD leader speak at your next event, please complete this form at least 8 months in advance of the meeting date. The request will assist staff in checking availability of and coordinating with AGD leaders who may be available to attend local constituent programs and events. If you have any questions or concerns, please contact us at 888.243.7392.

Please complete the following information:

1. Constituent name:
2. Date of event: Required
3. Type of event:
4. Location of event (City and State):
5. Constituent Contact name for event:
6. Contact e-mail:
7. Contact phone:
8. Airport closest to event:
9. Name of meeting site (hotel, resort, etc.):
10. Constituent can assist the AGD Officer by paying for the following expenses:
Hotel Ground Transportation
Air Parking
Meals Per Diem
11. Is this a request for an EC Member and/or other than the Vice President?
President President Elect
Vice President Secretary
Treasurer Speaker of the House
Editor IPP
12. Reason for officer other than the Vice President:
13. Time the event begins and ends: to
14. Time AGD Officer should arrive:
15. Time AGD Officer can depart:
16. Time AGD Officer appears on agenda or program:
17. Topic(s) AGD Officer should address: Required
Welcome and Remarks Installation of Officers
Organizational Vision Speech Other

Please submit this form to CST at least 8 months prior to your scheduled meeting.