By completing and submitting this form, you are indicating your desire to be appointed to a committee within CPhA.  You acknowledge that committee appointments are considered and approved by the CPhA Board of Trustees and will be effective at the conclusion of the annual House of Delegates meeting. 

The deadline to submit nominations is March 11, 2021.

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* 1. Please tell us who you are and how to contact you.

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* 2. Which category describes your membership category within CPhA?

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* 3. What is your primary pharmacy practice setting(s)?

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* 4. Which CPhA Local Chapter(s) are you affiliated with?

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* 5. In order of preference, please select the committee(s) you are seeking appointment for.   

  No interest Somewhat interested Neutral Very interested Extremely interested
Finance & Audit Committee (3-year term)
Awards Committee (3-year term)
Editorial Review Committee (3-year term)
Education Advisory Committee (2-year term)
Nominating Committee (3-year term)
House Nominating Committee (1-year term)
Policy Committee (2-year term)
Reference Committee (1-year term)

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* 6. Please list your prior appointed and elected positions you have held with CPhA and other pharmacy related associations.

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* 7. What other leadership and/or volunteer experience do you have that would be valuable in the position(s) you are seeking?

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