APTANJ Nomination Form - 2026 Elections
Please complete the below form to submit your name or a colleague's name to serve as a potential candidate for office with the American Physical Therapy Association of New Jersey. These forms will be reviewed by the Nominating committee.
Please state the first and last name of the person you would like to nominate for office. If it is yourself, simply put your first and last name in the box below.
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For the person that is being nominated, please select the appropriate designation:
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Please Select
Physical Therapist
Physical Therapist Assistant
Please identify the position you would like to run/nominate someone for (you may select more than one position)?
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President Elect
Vice President
Secretary
Chief Delegate
Delegate
Nomination Committee (North)
Nomination Committee (South)
Provide the address for the person that is being nominated (if known- otherwise state unknown)
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Phone number for the person being nominated (if known- otherwise state unknown)
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Please enter a valid phone number.
Format: (000) 000-0000.
Email for the person being nominated
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example@example.com
Employer of the person being nominated.
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Is Financial incentive for election provided by your employer? If you are nominating another individual, answer to the best of your ability or state unknown
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Yes
No
Unsure
Submit
Should be Empty: