MSMC Board Nominations
Nominees must be members in good-standing in the Society. Directors are elected to 3-year terms and may serve up to 2 consecutive terms.
Nominee Information
Name
*
Credentials
*
MD, DO, other
Specialty
Organization
*
Primary practice
Email
*
example@example.com
Nominated By
Self-Nomination
I am self-nominating (If checked, please skip to the next section)
Full name
Credentials
Organization
Email
example@example.com
Nomination Statement
Statement: Please submit a short statement of support for the nominee, or if this is a self-nomination then please submit a candidate statement.
*
CV
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Picture
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Submit
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