Objectives

The
The purposes for
which this club is Progressive
organized are: Club
To promote good
of the Chicago Dental Society
fellowship among our
members as well as
those of the other CDS
political groups;
To maintain and
promote qualified The
members within the
framework of
Progressive
organized dentistry. Club
of the Chicago Dental Society

Membership
Application
 Please print (must be legible):
xtx
APPLICATION The completed application should
be returned to the Progressive
membership chair: Name
I hereby apply for membership
in THE PROGRESSIVE CLUB, and
Specialty (if applicable)
agree, if accepted, to abide by
all the rules and regulations of MAIL TO:
MAIL
the club. My application is Dr. Mark
Dr. Mark Ploskonka
Ploskonka CDS Branch (required)

tendered with the 1818 Kelly

7845 S. Cottage Ct. Ste 105
Grove
understanding that I may resign
Darien, IL
Chicago, IL60561
60619
from the club, in writing, at any
Business name (if different from above)
time.
773-846-6000
773-846-6000
The Members shall:
Business Address
operate the Club without Ploskonka@msn.com
ploskonka@msn.com
profit and shall be City/State/Zip
nonsectarian;
be tolerant of the Enclose the annual membership dues of Phone
opinions and beliefs of $40.00 payable to:
fellow members;
Fax
s pport the Cl b s The Progressive Club
participation in the Dental Email (required)
Society activities;
assist in the promotion of
the Cl b s social program
Residential Address

Please note: All correspondences of The

Progressive Club are sent via email. All City/State/Zip
new members are inducted into
membership annually as the last order Phone
of business at the Caucus Night
meeting.