Application Form

Ambassador Program

Apply to be a Dimensions of Dental Hygiene Ambassador by submitting the form below.
Please whitelist announcements@dimensionsofdentalhygiene.com to make sure you receive your decision email.

Please fill out the application thoroughly.

First name *

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Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Last name *

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Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Credentials (N/A if you are a student) *

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Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

License Number (N/A if not applicable) *

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Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Email *

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Home Address (please include Street Address, City, State, Zip) *

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Phone Number *

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Areas of Expertise (eg. public health, oral cancer, oral infections, advocacy, education, administration, dental research) *

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Please enter a valid phone number

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Website/Blog

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Facebook

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Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Please enter a valid Facebook URL starting with https://www.facebook.com/

Instagram

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Please enter a valid web address. Must start with http:// or https://

Please enter a valid Instagram URL starting with https://www.instagram.com/

TikTok

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Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Please enter a valid TikTok URL starting with https://tiktok.com/@

Twitter

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Please enter a valid web address. Must start with http:// or https://

Please enter a valid Twitter URL starting with https://twitter.com/

YouTube

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Please enter a valid web address. Must start with http:// or https://

Please enter a valid YouTube URL starting with https://www.youtube.com/

Why would you make a good Dimensions of Dental Hygiene Ambassador? *

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Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Industry Affiliations or Employment (N/A if not applicable) *

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Online Activities (outside of social media) *

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Were you referred by someone? (yes/no) (If yes, please enter their first and last name) *

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Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

Are you a dental hygiene student? (yes/no) *

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Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

If yes, what is your expected graduation date?

This field is required

Please enter a valid email address

Please enter a valid phone number

Please enter a valid web address. Must start with http:// or https://

By agreeing to serve as a Dimensions of Dental Hygiene Brand Ambassador, I agree that my profile and bio sketch may be used in promotional materials from time to time. *

Please tick to accept

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