2012 ASSH Council Application

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Thank you for your interest in applying for the Vice President, or Council Member-at-Large, over eight year or under eight years, positions. Volunteer leadership is crucial to the success of our organization. All applicants are encouraged to attend the Members' Business Meeting at which the nominees will be presented for vote by the membership. The Members' Business Meeting will be held on Thursday, September 6th.

Please complete the following online application and email your electronic CV (Please limit to four (4) pages in length) AND two letters of recommendation to Alexzandra Wallace at awallace@assh.org at the ASSH Central Office by July 16, 2012.

You are also required to complete the ASSH Conflict of Interest Disclosure. Click here to view the ASSH Conflict of Interest Policy.

To complete your disclosure, please visit the ASSH website in the My Profile section. Select "Disclosures" from the top, right corner, and then update.
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1. Please enter your name, email address and cell phone number.
Qualifications and Commitments
Please read through the qualifications and commitments expected of all Council members and the specific duties of each position.

Vice President:
To apply for the office of the Vice President an individual who shall have been an Active member for 5 years prior to the time of election shall be eligible for nomination as an officer. Prior service on Council is required.

Member-at-large (Over and Under 8 years):
To apply to be Member-at-large you must be an ASSH Active Member.

2. I have read the description of the position for which I am applying, and I appreciate the responsibilities associated with such position. I hereby represent that, if appointed to such position, I will commit myself to the position and will fulfill such responsibilities to the best of my ability.
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3. Please select the position for which you are applying.
4. What year did you join ASSH?
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5. Primary employer:
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6. Board certification:
7. Please describe past volunteer contributions you have made to ASSH COMMITTEES.
8. Please indicate any ASSH COURSE CHAIR positions you have held in the past.
9. Please indicate any ASSH INSTRUCTOR positions you have held in the past.
10. Please indicate whether you have served on the AFSH BOARD in the past, and if so, indicate the position you held.
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11. Additional memberships (Please indicate any Board positions currently held that may present conflict in the "Other" box):
12. Please indicate your areas of medical interest/expertise that would enhance your Council board participation:
13. Please describe any interests you have outside of medicine that could enhance your contributions to the Hand Society in general:
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14. Please give names of two ASSH members who will be writing your letters of support.

Note: It is your responsibility to have these two members email or mail their letters of support so they arrive c/o Alexzandra Wallace at the ASSH Central Office by July 16, 2012.

Please note our new address!
822 W. Washington Blvd.
Chicago, IL 60607

15. Additional comments (optional):
Thank you for your online application.

Please be sure that all of your completed application materials arrive at the Central Office by July 16, 2012:
1) Electronic CV (Please limit to four (4) pages in length.)
2) Two member letters of support
3) Completed conflict of interest disclosure

Alexzandra Wallace
ASSH
822 W. Washington
Chicago, IL 60607
awallace@assh.org
Fax: 847-384-1435
Select "done" below to submit your online Council Position Application.
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