AAMI Leadership Nomination Form

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* Office being sought:

Chair-Elect

Treasurer

Vice-Chair (1)

Director

Nominating Committee (2)

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* Information:

Name:

Title:

Company:

Address:

Address 2:

Office phone:

Cell phone:

Email:

Education Degrees:

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* Numbers of years as an AAMI member:

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* AAMI Committee roles:

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* Authorship in AAMI publications:

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* Other AAMI participation or activities:

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* Attach your letter of interest here:

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* Submit a recent curriculum vitae here:

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* Letter of recommendation (optional)

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* Letter of recommendation (optional)