Volunteer Sign-Up Form
"start where you are, use what you have, do what you can"
Dentists for the Disabled and Elderly in Need of Treatment, Inc.
Your Full Name *
Your answer
Email *
Your answer
Dental Office Address *
Your answer
Dental Office Phone Number (including area code) *
Your answer
Dental Office Fax Number (including area code)
Your answer
Dental Office Contact Name *
Your answer
Website
Your answer
I am a *
Oklahoma Board of Dentistry License Number *
Your answer
Please select population you feel most passionate about helping through D-DENT: *
Required
I would love to help restore the oral health of: *
Required
What type of dental work will you provide through D-DENT?
My office is wheelchair accesible *
Thank you for allowing us to help you make a difference, one smile at a time.
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