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* 1. Basic Contact Information

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* 2. What is your EMS license level?

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* 3. What is your state license number?

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* 4. How many years of EMS experience do you have?

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* 5. Which other EMS organizations do you belong to?

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* 6. Which EMS agency do you run with?

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* 7. What is your current position with your EMS agency?

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* 8. Please select which areas of WEMSA you are most interested in participating in on the Board of Directors.

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* 9. Provide a short bio that could be published on the WEMSA BOD ballot and/ or in public-facing publications should you be selected.

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* 10. Please describe your interest and involvement in EMS, why you feel that you would be an asset as a member of the Board of Directors for WEMSA, and/or how your experience in the EMS field has inspired you to apply for a Board of Directors position with WEMSA.  Please include a challenge that you feel EMS is (or will be) facing in Wisconsin, and how you propose we work with various stakeholders to develop/ implement solutions to mitigate this challenge.

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* 11. Please upload your letter of recommendation.

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* 12. Please upload your resume/ CV.

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