VCSQI Board of Directors Nomination Form

VCSQI Board of Directors Nomination Form

Nominate yourself or a colleague and share why they would be a strong fit for the Board.
Are you nominating yourself?
Your Name

First NameLast Name
Your Email Address
example@example.com
Nominee’s Name

First NameLast Name
Nominee’s Organization / Hospital
Nominee’s Email Address
example@example.com
Why are you nominating this individual for the VCSQI Board of Directors?
Please briefly describe their/your leadership, experience, involvement with VCSQI, or what they/you could contribute to the Board.
Please upload your CV

Cancelof
Nomination Acknowledgment: I understand that submitting this form places the individual’s name into consideration for VCSQI Board service.
Should be Empty: