ACPOC Member Spotlight

ACPOC Member Spotlight
ACPOC members are essential to achieving our mission of improving quality of care for patients. Starting in October, ACPOC will recognize a member of the month to help display the personal and professional accomplishments of our members, and to encourage members to network with one another. Featured members will be highlighted in our ACPOC news, social media channels, and on the ACPOC website.

If you would like to nominate yourself or a colleague, please submit your information and a photo.

*Please note, all Members of the Month must be ACPOC members at the time of publication.
Name*

First NameLast Name
Email*
example@example.com
Work place and position*
Ala Mater*
Short Description of your Professional Career or Background*
Tell us about your family*
Special interests *
Why is ACPOC important to you?*
Headshot or Family Picture*

Cancelof
Would you like to share a research or case study in the ACPOC News?*

YesNoOther
Upload Research or Case Study Here:

Cancelof
STANDARD PHOTO RELEASE FORM

I hereby authorize the Association of Children’s Prosthetic-Orthotic Clinics to publish the photographs of me, and my name, for use in ACPOC’s publications, website and social media accounts.

I acknowledge that since my participation in publications, websites and social media accounts produced by ACPOC is voluntary, I will receive no financial compensation.

I further agree that my participation in any publication, website and social media accounts produced by ACPOC confers upon me no rights of ownership whatsoever. I release ACPOC, its contractors and its employees from liability for any claims by me or any third party in connection with my participation.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: