NCHCFA 2018-2020 Committee Volunteer Form Question Title * 1. Name OK Question Title * 2. Title/Position OK Question Title * 3. Facility/Company Name OK Question Title * 4. Mailing Address OK Question Title * 5. City/State/Zip OK Question Title * 6. Email Address OK Question Title * 7. Why would you like to serve? OK Question Title * 8. Please rank in order you wish to be appointed: 1 2 3 4 5 6 Council on Provider Relations Committee 1 2 3 4 5 6 Education and Programs Committee 1 2 3 4 5 6 Payment for Services Committee 1 2 3 4 5 6 Standards and Ethics Committee 1 2 3 4 5 6 Quality Advisory Committee 1 2 3 4 5 6 Social Media/Communications Committee OK DONE