Thank you for your interest in serving on the Iowa Cancer Consortium Board of Directors. Before submitting this candidate information form, please review the following Iowa Cancer Consortium materials (Board Member Job Description, Brand Identity Guidelines, and Conflict of Interest Policy). 

Completing this form is a requirement for all who intend to run for the board. It must be completed by midnight CST on November 16, 2018. Elections will be held electronically December 3-14, 2018. The Board of Directors is elected by Iowa Cancer Consortium members. Questions about this process may be directed to Kelly Sittig at sittig@canceriowa.org or (319) 335-8816.

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* 1. Full Name

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* 2. Organization, if applicable

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* 3. Email address

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* 4. Phone number

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* 5. Street address

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* 6. City

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* 7. Zip

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* 8. Are you currently an Iowa Cancer Consortium member?

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* 9. I am running for the following Board of Directors seat:

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* 10. Do you understand and can you commit to the expectations described in the Consortium Board Member Job Description, Iowa Cancer Consortium Brand Identity Guidelines and Conflict of Interest Policy?

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* 11. Personal Statement: In 500 words or less, please describe why you are interested in serving on the Iowa Cancer Consortium Board of Directors. Please include descriptions of applicable education, training and/or experience.

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