Speaker Needs Form

  • Presenter Information

  • Equipment Requirements

  • (NOTE: Speakers are required to bring their own laptop.)
  • Housing Requirements

  • The Michigan Dental Association normally pays for your room the night before your presentation unless contract specifies otherwise. The MDA is not responsible for additional nights or additional in-room person charges or expenses.

  • Biographical Information

  • Presentation Information

  • Please input your suggested wording in 150 words or less, a synopsis/summary of your program (including bulleted learning objectives) that can be used for publication purposes. NOTE: The MDA will shorten the synopsis to fit space requirements. Include the following information:

    • Bulleted learning objectives (minimum of three).
    • Unique aspects of the program.
    • Any benefits the audience will derive from attending this program.
    • Who will benefit from this program (i.e. dentists, hygienists, assistants, business staff).
    • The immediate “pay-offs” to attending the program.
  • NOTE: Keep course title to 10 words or less. If title exceeds word limit, MDA will shorten it for space.

  • NOTE: Keep course title to 10 words or less. If title exceeds word limit, MDA will shorten it for space.
  • Presentation Handouts

  • Please view the MDA's Speaker Handout Rules.

    NOTE: MDA does not reimburse for copying. Materials must be received 30 days prior to program date either by mail or email.
  • File Upload: Use the feature below to include your presentation handouts with this form submission. Submit all handouts in PDF format. For Powerpoint presentations, choose the 3 Slides choice in your Print Options menu before converting to PDF.

  • Drop files here or
    Accepted file types: pdf, .
  • Drop files here or
    Accepted file types: pdf, .
  • Photograph

  • The MDA requires a high-resolution, color, professional portrait (see examples below). Please follow these guidelines:

    • Send the original digital image.
    • Do not send an image copied from your website.
    • Only send .jpg or .png images.

    Photos meeting these requirements can be attached to this form using the upload option below. If you must send a printed image by mail, please write your name on the back. NOTE: Photos will not accompany course descriptions of speakers who do not send images meeting these requirements.

  • Accepted file types: jpg, png.