​NCDHM Reporting Form

Congratulations on an outstanding National Children's Dental Health Month event! Please complete ALL sections of the form below.​

Category of Program

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

All entries must be submitted by April 1.

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