2010 Practice Division Director Application

Thank you for your interest in applying for the Practice Division Director position on Council. Volunteer leadership is crucial to the success of our organization.

Please complete the following online application and email/mail your electronic CV and two(2) letters of recommendation to:
Alexzandra Wallace
awallace@assh.org
ASSH 6300 North River Road
Suite 600
Rosemont, IL 60018
Fax: 847-384-1435

Applications and supporting materials are due September 30, 2010.

Qualifications and Commitments


Please read through the qualifications and commitments expected of all Council members, Council Conflict of Interest Policy, and the specific duties of this position before proceeding.

You are required to complete the ASSH Conflict to 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. Click on "Edit" in the lower right corner, and then click on the "Conflict of Interest" tab.
Note: Please enter today's date in the "Current date" field.
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1. Please enter your name and email address.
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2. I have read the description for 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.
3. Year you joined ASSH:
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4. Primary employer:
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5. Board certification:
In the questions below, please indicate what past volunteer contributions you have made to the ASSH and when they took place in the following categories: Committees, Course chair, and Instructor.
6. Committees
7. Course Chair
8. Instructor
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9. Additional memberships:
10. Areas of interest/expertise within medicine that would enhance your Council board participation:
11. Interests outside of medicine that could enhance your contributions to the Hand Society in general:
12. Names of 2 ASSH members who will be writing letters of support.

Note: It is your responsibility to have these two members email/mail in their their letters of support to Alexzandra Wallace at the ASSH Central Office by September 30, 2010.

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