ASDC Committee Nomination Form

Expression of interest - ASDC Committee

Are you interested in being involved with the Australian Society of Dermal Clinicians boards, committees or working groups.
Name:*

First NameLast Name
E-mail Address:
example@example.com
Phone Number:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you interested in a role on one of the following boards or working groups (open to all members)*

Industry advisoryEducation BoardGovernance and Policy BoardMember Engagement BoardStudent Board (student members only)Working Party - Practitioner Certification SchemeWorking Party - Education Accreditation SchemeWorking Party CPE ReviewConference Organising CommitteeEditorial BoardFinance and Risk committeeMarketing and Media BoardNone
Are you interested in a role on the executive board? (must be a full member)*

President (Chairperson)General SecretaryVice President (Chairperson)TreasurerExecutive Board MemberNone
Have you had experience in board management*
All executive board members (directors) of the executive board of the Australian Society of Dermal Clinicians are required to have a Directors ID as we are in incorporated association with registration with ASIC and Consumer affairs.

More information on Directors Identification Numbers
Do you currently have a directors identification number?

YesNoNot currently but will organise this before AGM
Provide a short (250 word) overview of your experience with board or committee activities.

What is your level of experience in the listed areas we require?*

	None	Min. experience	Experienced	Very experienced
Project/Event Management
Financial planning/book keeping
Industry Engagement
Website management
Media and marketing
Graphic design
Editorial
Procurement negotiating & purchasing
Industry networking and engagement
Policy writing
Grant applications
Education
Accreditation and benchmarking
Sponsor engagement
Government lobbying/political engagement

What level of experience do you have in the following?*

Expression of interest - ASDC Committee