Thank you for applying to serve on an ACDIS board or committee!

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* 1. Please provide your name, credentials, and contact information.

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* 2. Please indicate whether you work as a consultant or in the provider/hospital setting.

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* 3. How long have you been in the CDI profession?

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* 4. Are you an ACDIS member? (Please note, all ACDIS committee members must be ACDIS members.)

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* 5. Please upload your headshot and professional bio (in one file, please).

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