2021 Nominations

LEADERSHIP PROFILE FORM – NOMINEE FOR BOARD SERVICE

Please complete all the fields below.
The more information you include about the candidate gives the Nominating Committee a complete profile of the candidate for a thorough review and selection process.

Contact Information

Your Name:

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Candidate Name:

Candidate Email:

Please consider candidate for the following position(s): (Select all that apply) Second Vice-President Treasurer-elect Secretary-elect Director-at-Large Junior Director-at-Large Nominating Committee

Is Candidate willing to serve in the role indicated above? Yes I don't know

Candidate Background

Academic degrees(s):

Clinical Specialty (if applicable):

Current Employer:

Contributions to the Field

Please list leadership, academic, research or other achievements or other reasons why you feel this candidate would be ideal for this position.

Leadership Skills

Briefly describe below the qualities and skills this candidate can bring to the position and how they can help further the goals and mission of the AACPDM.

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2021 Nominations

LEADERSHIP PROFILE FORM – NOMINEE FOR BOARD SERVICE

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