NTDS Pro Bono Registration

Please complete the information below about your pro bono work. Contact Lisa McLerran at ntds4@yahoo.com or 469-855-9965 with any questions.



		
									NTDS ProBono Registration
							
		
						
									
						Dentist Name *
						
					
							
						
									
						Month of Treatment *
						
					
							
						
									
						Amount of Time *
						
					
							
						
									
						Value of Treatment *
						
					
							
						
									
						Number of Patients *

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