Dental Professional Learning Network (DPLN) Resource Information Form

Thank you for being a resource for our AADOM DPLNs. With your AADOM Corporate Membership you are being offered a listing on our DPLN Resources page. Please provide the below information so we can connect you with AADOM DPLNs across the country.

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Company Name*
Contact Name*

The person's information you give here will be the point of contact for AADOM DPLN inquiries to your company
Contact Email*
Contact Phone
List your phone number ONLY if you want it listed on our resource page
Company Website*
What area(s) of the country are you willing to support?*
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What resources would you like to provide our Dental Professional Learning Network (DPLN - local study clubs)?*
We recommend you provide a bulleted list of resources you are willing to provide to a chapter – Example: Local Speaker - Video Presentation with live Q and A - Snack Sponsor up to $XXX - Provide a conference room for DPLN meetings/events, etc.
Please upload your logo*
Allowed file types: jpg, png
Drop files here or

Accepted file types: jpg, png, Max. file size: 9 GB.
Anything special you want the AADOM DPLN Leaders to know?
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Comments
This field is for validation purposes and should be left unchanged.

Dental Professional Learning Network (DPLN) Resource Information Form

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