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2027 ASNC Committee Interest Form - Due by October 26
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1.
Full Name (Last, First, Middle Initial)
(Required.)
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2.
Organizaton
(Required.)
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3.
Address
(Required.)
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4.
Phone Number
(Required.)
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5.
Primary Email (used for ASNC communications)
(Required.)
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6.
Committees of Interest - 1st Choice
(Required.)
2028 Annual Meeting Program Committee
CV PET Committee
Education Committee
Health Policy Committee
Member Relations Committee
Committee on Guidelines & Scientific Statements
Technologist Advisory Panel
Diversity & Inclusion Task Force
FIT/Early Career Work Group
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7.
Have you served on this committee before?
(Required.)
Yes
No
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8.
Committees of Interest - 2nd Choice
(Required.)
2028 Annual Meeting Program Committee
CV PET Committee
Education Committee
Health Policy Committee
Member Relations Committee
Committee on Guidelines & Scientific Statements
Technologist Advisory Panel
Diversity & Inclusion Task Force
FIT/Early Career Work Group
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9.
Have you served on this committee before?
(Required.)
Yes
No
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10.
Why do you want to serve on the committee(s) of your preference?
(Required.)
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11.
What expertise will you bring to ASNC?
(Required.)
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12.
Have you served (or are you currently serving) on an ASNC committee? Please specify.
(Required.)
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13.
Excluding service on an ASNC committee, how else have you participated in ASNC?
(Required.)
14.
Please describe other ASNC volunteer opportunities or ways you have contributed to the Society.
15.
If you are not selected to serve on a committee, what other ASNC volunteer opportunities would you be interested in?
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16.
Please upload your curriculum vitae.
(Required.)
Only PDF, DOC, DOCX files are supported.
Choose File
No file chosen
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17.
Please upload 2 Letters of Recommendation.
(Required.)
Only PDF, DOC, DOCX files are supported.
Choose File
No file chosen
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18.
Disclaimer and Signature: If appointed to an ASNC committee, I agree to disclose to ASNC any relevant financial relationships with any commercial interest that produces health care goods or services consumed by or used on patients, including computer software/hardware, related to the content of a committee activity. I confirm that all information provided is true to the best of my knowledge.
Enter your signature below.
(Required.)
