Committee Volunteer Form
One of the greatest gifts you can give is your time.
Name
First Name
Last Name
E-mail
Please list your full name and credentials as it should be listed on the official documentation and website.
example: SarahAnn S. Whitbeck, MBA, FACEHP, CHCP
Please indicate which committee(s) you would like to volunteer for - and rank accordingly.
Rows
Committee Name
Ranking
Database committee
1
2
3
4
5
6
Development committee
1
2
3
4
5
6
Education committee
1
2
3
4
5
6
Ethics Advisory committee
1
2
3
4
5
6
Membership committee
1
2
3
4
5
6
Nominating committee - seeking an APP specifically
1
2
3
4
5
6
Publications committee
1
2
3
4
5
6
Research committee
1
2
3
4
5
6
Please provide a short description about your qualifications for the above-noted volunteer role(s) and any prior volunteer/professional roles that demonstrate applicable skills. (Preferably at least 100 words)
By signing herein, I affirm the above information is accurate and complete.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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