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How to Participate

It is commonly observed and reported that improved appearance can have a significant impact on a person’s academic, professional and personal success. By establishing a local chapter of the Smile for a Lifetime Foundation in your community, you’ll be helping an individual in need receive a beautiful, healthy smile they can be proud of.

Please view the video below to learn more about the life-changing benefits of a straight, beautiful smile! If you are an orthodontist interested in starting a local chapter in your area, please complete and submit the form below. You can also request an application via e-mail from our National Executive Director, Aimee Spencer. This application allows the board to ensure proper coordination between the orthodontists and chapters.

Contact Information/Information for Proposed Chapter:

All fields are required

Name:*

Address:*

Phone:*

E-mail:*

Regional area to be covered by the Chapter:*

Number of cases to be given per year (must be at least six):*

Sponsoring orthodontist of the local chapter to provide the services:*

Proposed initial Board of Directors for the local chapter (eight to twelve): Please list with names, occupations, address, and phone numbers.*

Proposed Officers for the new chapter to include President, Secretary and Treasurer. Please list with names, occupations, address and phone numbers.*

Do you plan on hiring a Director to handle the daily affairs of the local chapter? If yes, who will this person be? If no, who will be responsible for handling the daily affairs of the chapter?*

Has any person or organization committed to making a gift to the local chapter? If so, who has made the commitments, and how much has been committed?*

Who will be responsible for local publicity and promotion? How do you plan on promoting and publicizing the chapter in your region?*

Proposed new chapter name: Smile for a Lifetime -*

Submit

* Required