Apply for WSDA/ADA Elected Positions

The following WSDA and ADA elected positions are up for election at the 2021 House of Delegates:

President-elect (1 position)
Board of Directors (8 positions - 4 full term, 4 partial term)
Delegate to the ADA (6 positions - 3 full term, 3 partial term)

Expand "Position Details" below to learn more and see requirements for each position. Please fill out the form on this page to apply.

Application Deadline: June 17, 2021

Position Details
President-elect
- Open Positions: 1
- Term: 1 year as President-elect, 1 year as President, 1 year as Immediate Past President, 3 years as ADA Delegate (2022, 2023, 2024). Term will begin when the WSDA House adjourns on Sept. 11, 2021.
- Requirements: WSDA member. Must have been a member for the preceding five consecutive years.
Board of Directors
- Open Positions: 8 (4 full term, 4 partial term)
- Term: 3 years (full term), 2 years (partial term). Term will begin when the WSDA House adjourns on Sept. 11, 2021.
- Requirements: WSDA member
ADA Delegate
- Open Positions: 6 (3 full term, 3 partial term)
- Term: 3 years (full term), 2 years (partial term). Full terms will run from 2022-2024. Partial terms will run from 2022-2023. Term will begin on Jan. 1, 2022.
- Requirements: WSDA member. In accordance with WSDA’s Bylaws, one delegate position will be reserved for a person that has never been elected to the ADA House and has previously served at least one year as a WSDA-appointed alternate delegate, ASDA delegate, or alternate delegate to the ADA House. The First Time delegate will be a full term position.

WSDA House of Delegates

Sept. 9-11, 2021
Davenport Hotel, Spokane

Candidates should plan to be present for elections at the 2021 WSDA House of Delegates.

Application

Personal Information

First Name

Last Name

ADA Number

Address

Home or office address?

Home
Office

Phone Number

Cell, office, or home phone?

Cell
Office
Home

Do you have a Board Certified specialty?

Yes
No

If so, list specialty.

Current Positions (Limit 5)

List organization, position, and years served for up to 5 current positions.

Former Positions (Limit 5)

List organization, position, and years served for up to 5 former positions.

Professional Affiliations (Limit 5)

List up to 5 professional affiliations.

Education

List degree, university and year earned for degrees held.

Other (Limit 5)

List organization, position, and years served for up to 5 additional affiliations.

Office & Candidate Statement

Select the office you will be running for.

Include your candidate statement. Limit 250 words.

Candidate Photo

Please upload a high-quality headshot.

Conflict of Interest

Applicants must read WSDA's Conflict of Interest Policy prior to submission.

WSDA Conflict of Interest Policy

I have read and understand WSDA’s Conflict of Interest policy as stated in Bylaws IV.I (4.I) and Standing Rule 4.4.

Yes, I have read and understand the policy