Thank you for your interest in volunteering for the ACMP Midwest Chapter! Please complete this interest form by March 30, 2018 to be considered as for a volunteer role for the 2018/2019 term.

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* 1. Are you an ACMP member?

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* 2. Please provide the following information:

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* 3. Please indicate your preferred Chapter area to volunteer by ranking 1 to 3 (with 1 being your highest preference).

  1 2 3
Membership
Professional Development
Marketing
Events
Partner Relations
Operations
Executive Board Administration

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* 4. Have you served on an ACMP volunteer committee before?

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* 6. Why are you interested in volunteering for the ACMP Midwest Chapter?

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* 7. Please share what skills and experience you have to contribute as a Chapter Volunteer. (be specific as it might relate to the areas for which you are interested)

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* 8. Please describe your previous volunteer experience (if any) you've had with a not for profit organization.

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* 9. Please answer the following ethics questions:

  Yes No
Have you ever been found by any professional association to which you have belonged to have violated its ethical code or are you currently under investigation for an alleged ethical violation by any professional association to which you belong?
Are you involved in any relationships, personal, professional or otherwise directly or indirectly, which may raise a potential conflict of interest regarding your service to ACMP?
Do you have any contractual or financial relationship with ACMP Midwest? (i.e. sponsorship)
I agree to adhere to the ACMP Code of Ethics and Professional Conduct.
Do you agree to fully disclose to the Board of Directors any potential conflicts of interest related to any relationships?
Thank you submitting your interest to volunteer with the ACMP Midwest Chapter. As a reminder, interest will be reviewed by the Board of Directors and notifications will be sent out by the end of April. For more information please visit our website www.acmpmidwest.org.

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