WHPRMS Leadership Application

WHPRMS Membership
How many years have you been a WHPRMS member?*
WHPRMS Involvement
If you have served in any of the WHPRMS roles listed below, please check the appropriate boxes.

Committee MemberBoard MemberPresident
How many years did you serve in the WHPRMS role(s) selected above?
Other Professional Organization Participation
List all other public relations or marketing organizations on a national, regional, state, or local level that you are involved with. Include how many years you have been a member, along with your role in the organization (member, board member, committee member, etc.)

Education (In this division, the applicant may accumulate points for the number of years of higher education completed.)
Healthcare Years of Experience
Continuing Education (List any PR or marketing related webinars/seminars/workshops that you have attended).
List any accreditations you have received (APR, ACHE, etc.)
How many times have you attended the WHPRMS Annual Conference?
List any national conferences/seminars you have attended (PRSA, SHMD, etc.)
Awards and Recognition (list any awards you have received from WHPRMS, along with any other national/regional awards. Ex: Carol Scaife Memorial Scholarship, Prestige Award of Merit/Excellence, Carol Mehlberg Award, Professional Excellence Award.)
Contributions to Healthcare (Include the following examples: wrote an industry-related blog (up to 5) | spoke as a guest lecture in a marketing/public relations class | quoted in an industry-related article (online, magazine, etc. - up to 5) | presented a PR or marketing related seminar/workshop/webinar | published a paper in a trade journal | spoke/presented at the WHPRMS annual conference | taught a college course on marketing/public relations | spoke/presented at a national conference | spoke as a keynote speaker at WHPRMS conference or other regional conference | published a book | spoke as a keynote speaker at a national conference

Attachments
Photo*

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Brief Biography

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Letters of Recommendation

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If you are applying to be a Fellow, please upload two letters of recommendation to submit with your application. Cancelof

Statement by Applicant
I hereby attest to the accuracy of the information contained in the application and understand that any false statement or misrepresentation I make may result in the revocation of this application. I authorize WHPRMS to make any inquiries that are necessary in ascertaining my fitness for advancement in the Leadership Recognition Program, and I agree to abide by their decision.*

I agree
Payment Method*

Credit/Debit - You must click on the payment link below.Pay by Check
If you're paying by credit or debit card, you must click on this link to pay (another window will open and you can come back and click submit). If paying by check, please submit this form and then send payment in the amount indicated above for the Leadership level you're applying for.

WHPRMS
563 Carter Court, Ste B
Kimberly, WI 54136
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WHPRMS Membership