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GKAS Reporting Form

Congratulations on an outstanding Give Kids A Smile event! Please complete ALL sections of the form below.​

Category of Program

Did any other group(s) co-sponsor the event?

Did any politicians attend?

Photographs may be included with your submission. Such materials may be transmitted by e-mail to, or by postal mail (see below).

All entries must be submitted by April 21.

Return to:
Attn: Lee Ann Beane
IL State Dental Society
P O Box 376
Springfield, IL 62705
Fax: 217/525-8872