Chapter Session Submission Form
To apply to present a breakout session at ASDA’s National Leadership Conference in Chicago,
e-mail the following to [email protected] at ASDA central office by Aug. 18:
1. Completed session submission form describing the topic and learning objectives.
2. A 2-3 minute video of the potential speaker(s) explaining the session or presenting a
portion of the session.
Your chapter may submit up to two sessions for consideration. You must complete a
submission form and send a video for each one. ASDA will cover NLC registration and travel for
one speaker. Up to two people can present the session together.
Chapter: ______________________________________________________________________
Main contact: __________________________________________________________________
E-mail address: _________________________________________________________________
Session title: ___________________________________________________________________
Speaker 1: _____________________________________________________________________
Speaker 2: _____________________________________________________________________
In 70 words or less, describe your session for inclusion in pre-event marketing, the NLC
mobile app and meeting program:
Example: For many dental students, ASDA is their first experience in organized dentistry. Learn
about ASDA’s goals, structure and how you and your chapter fit in to the overall mission of the
organization. Find out how your early involvement in ASDA, and your local and state dental
associations, can ensure your future success.
Include 2-3 specific learning objectives:
● Attendees will learn how to manage their chapter committees
● Attendees will learn how to improve their website

Chapter Session Submission Form