APTA Federal Nomination Form (including SIGs) - Election 2024

The following will start their terms of office in January 2025.

Membership Chair (3 Years)
Communication Committee Member
Primary Care SIG - Co-Chair (2 Years)
Primary Care SIG - Research Chair (2 Years)
Primary Care SIG - Education Chair (2 Years)
Primary Care SIG - Advanced Privileging Chair (2 Years)
Pelvic Health Rehabilitation SIG - Chairperson (1 Year)

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* 1. Name of Nominee

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* 2. Nominee Email address

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* 3. Select office for nomination:

Membership Chair

Communication Commitee Member

Primary Care SIG - Co-Chair

Primary Care SIG - Research Chair

Primary Care SIG - Education Chair

Primary Care SIG - Advanced Privileging Chair

Pelvic Health Rehabilitation SIG - Chairperson

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* 4. Name and Email of person nominating if not self-nomination

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* 5. Nominee Bio and Candidate Statement

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 6. Candidate Photo

PNG, JPG, JPEG, GIF file types only.

Choose File