2018 Orthodontic Staff Appreciation Week Celebration Publicity Form

Instructions: complete this form in as much detail as possible. Submissions may be used as promotional content in AAO publications such as The Practice Management Bulletin or eBulletin. Forms must be completed by June 29, 2018 to be considered.

1. Contact information

First Name:

Last Name:

Position:

Practice/Business Name:

Practice/Business Address:

City:

State:

Zip:

Email Address: This question requires a valid email address.

Business Phone:

2. How many orthodontists are in your practice? This question requires a valid number format.

3. How many orthodontic staff are in your practice? This question requires a valid number format.

4. How did you celebrate? Please summarize your activities during Orthodontic Staff Appreciation Week (June 4-8, 2018) in the space provided limiting your response to 250 words.

5. Photo SubmissionPlease submit photos that were taken during your Orthodontic Staff Appreciation Week festivities (June 4-8, 2018). Photos are preferred as digital image files in .jpeg format.

You may submit up to five photos. Click "Browse" to select a file from your computer and click "Upload" to submit the file. Repeat these steps until all of your files are listed. You may click the red "X" to delete files, if necessary.

File: {{filename}} delete

6. Photo Release Form(s)In order for AAO to use the photos, please ensure each individual appearing in the photos signs a photo release.

Download form here, complete with your information, and save to your computer. Click "Browse" to select a file from your computer and click "Upload" to submit the file. Repeat these steps until all of your files are listed. You may click the red "X" to delete files, if necessary.

File: {{filename}} delete