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AUTHORIZATION TO RELEASE DENTAL INFORMATION I request and authorize ___ (name of dental office who has your dental records)to release dental information to: Benchmark Dental, LLC 104 Corn Shop Lane

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Submit the completed form according to the instructions provided by the Michigan Dental Association.

Who needs non-party michigan dental associations?

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Dental professionals who are not members of the Michigan Dental Association but wish to participate in association activities or events.

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Patients or other individuals who are interested in supporting or being involved in the Michigan Dental Association's work and initiatives.

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What is non-party Michigan dental associations?

Non-party Michigan dental associations are organizations that are not affiliated with any political party and are involved in the dental industry in the state of Michigan.

Who is required to file non-party Michigan dental associations?

Non-party Michigan dental associations are required to be filed by organizations in the dental industry that operate independently of any political party in Michigan.

How to fill out non-party Michigan dental associations?

Non-party Michigan dental associations can be filled out by providing information about the organization's activities, finances, and any political contributions or expenditures.

What is the purpose of non-party Michigan dental associations?

The purpose of non-party Michigan dental associations is to provide transparency and accountability for organizations in the dental industry that engage in political activities.

What information must be reported on non-party Michigan dental associations?

Information that must be reported on non-party Michigan dental associations includes the organization's name, address, activities, finances, and any political contributions or expenditures.

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