Largo Day of Giving Volunteer Form Date: Saturday, March 7, 2020 Time: 8:00AM – 2:30PM Location: Bright Now! Dental 10500 Ulmerton Road Suite 210 Largo, FL 33771 ***If you are unable to stay for the entire event, please contact Audrey Nguyen as soon as possible at (714) 428-1373 or audrey.nguyen@smilesforeveryone.org*** Name* First Last Email* PhonePosition*DentistOral SurgeonPeriodontistDental AssistantHygienistOffice ManagerFront OfficeDMOOther**Specialty or Other Position Type?How many patients are you comfortable seeing each hour?*12Are you trained in an additional area?YesNoPositionDental AssistantHygienistFront OfficeOther*Other Position TypeDo you speak an additional language?YesNoPlease list any additional languages spokenDo you need a new name badge?*YesNoPlease write your name and title as you would like it to be printed on your name badge.*What is your glove size?*XSSMLAre you affiliated with Smile Brands? (Bright Now, Castle, Monarch, Newport, A+, P3, etc.)*YesNoDo you need a new Community Smile Project t-shirt?*YesNoDo you need a new set of Smiles for Everyone Foundation scrubs?*YesNoScrub TopsWomen's XSWomen's SWomen's MWomen's LWomen's XLWomen's 2XLUnisex SUnisex MUnisex LUnisex XLUnisex 2XLUnisex 3XLScrub BottomsWomen's XSWomen's SWomen's MWomen's LWomen's XLWomen's 2XLUnisex SUnisex MUnisex LUnisex XLUnisex 2XLUnisex 3XLFront Office T-ShirtsWomen's XSWomen's SWomen's MWomen's LWomen's XLWomen's 2XLMen's SMen's LMen's XLMen's 2XLOffice Site Code (this is where your t-shirt will be sent)*Office Site Code (this is where your scrubs will be sent)*Please provide the address where you would like your tshirt to be sent*Please provide the address where you would like your scrubs to be sent*Do you have any dietary restrictions?*YesNoPlease list any dietary restrictionsAre you interested and available to help set up the afternoon before?YesNoWe will email you with specific times.
