HIPAA COW Board of Directors Application Form
Name
First Name
Last Name
Job Title
Company
Phone Number
-
Area Code
Phone Number
Email
example@example.com
CONSIDERATION QUESTIONS
What current involvement do you have with HIPAA COW (if any)?
What skills, resources and knowledge would you provide to the HIPAA COW Board?
How would you personally benefit from serving as a HIPAA COW Board Member?
Please list any committee or boards you have served on or are serving on, and what positions/titles you hold:
Do you have any HIPAA privacy experience?
Yes
No
If privacy experience, please explain:
Do you have any HIPAA security experience?
yes
no
If security experience, please explain:
Do you have conference planning experience?
Yes
No
If conference planning experience, please explain:
Are you willing to serve on other sub-committees within the organization?
Yes
No
Not sure
Please share any other information that would be helpful for us to know about you:
Bio (100 words or less)
Resume
Browse Files
attach your resume
Cancel
of
SUBMISSION
Please submit this completed form with your resume.
Submit
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