Apply for WSDA/ADA Elected Positions

The following WSDA and ADA elected positions are up for election at the 2021 House of Delegates:

  • President-elect (1 position)
  • Board of Directors (8 positions - 4 full term, 4 partial term)
  • Delegate to the ADA (6 positions - 3 full term, 3 partial term)
Expand "Position Details" below to learn more and see requirements for each position. Please fill out the form on this page to apply.

Application Deadline: June 17, 2021

  • Position Details

WSDA House of Delegates

Sept. 9-11, 2021
Davenport Hotel, Spokane

Candidates should plan to be present for elections at the 2021 WSDA House of Delegates.

Application

Personal Information

Home or office address?

Cell, office, or home phone?


Do you have a Board Certified specialty?

Current Positions (Limit 5)

Former Positions (Limit 5)

Professional Affiliations (Limit 5)

Education

Other (Limit 5)

Office & Candidate Statement

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.
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