ADHA IOH + Colgate BSBF Volunteer Opportunities

Thank you for your interest on being a volunteer aboard the Colgate Mobile Van Unit! Please select the state in which you are interested in volunteering. Once your state is selected you will see dates, cities and times of available sites where volunteers are needed. Then select the site that you wish to volunteer at, next please provide your contact information. Further information will be provide within 24 hours of the completion of this survey. *Please note visits are subject to change and notification will be made well in advance.

2. Select which AL event you wish to volunteer for:

2. Select which CA event you wish to volunteer for:

2. Select which FL event you wish to volunteer for:

2. Select which GA event you wish to volunteer for:

2. Select which MD event you wish to volunteer for:

2. Select which NC event you wish to volunteer for:

2. Select which NY event you wish to volunteer for:

2. Select which TX event you wish to volunteer for:

2. Provide your contact information below: *This question is required.

First Name

Last Name

Email Address

Mobile Phone

3. PHOTO CONSENT AND RELEASE
For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby grant to Colgate-Palmolive Company, American Dental Hygienists Association and the Institute for Oral Health Foundation, its subsidiaries, affiliates, agents, successors, legal representatives, assigns and those acting for or on its behalf including, without limitation, its advertising and publicity agencies (all hereinafter referred to collectively as “Company”), the perpetual, irrevocable right and permission to use, at any time and from time to time, my name, any pseudonym, my signature, my biographic data, my voice, my photograph(s) or likeness, or any part thereof, in any form (including caricature), and any statements made by me either alone or accompanied by other material (all of the foregoing elements are referred to collectively as my “Identity”), in any manner, throughout the world, for advertising, promotion, publicity, trade or any other lawful purpose, in any medium now known or hereafter developed including, without limitation, printed media, digital and electronic media, audiovisual recordings, still photographs and the Internet.

I represent and warrant that I have the right to use, and allow Company to use, any photograph(s) provided by me to Company for these purposes, and that my biographical information that I provided is accurate. *This question is required.

4. Volunteer Registration Form
This document is editable, please type in your information, save it to your computer then upload it by clicking on the "Browse" button below. If you are unable to unload the document please email it directly to Meetings@adha.net

Volunteer Registration Form_PDF *This question is required.

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