Question Title IPRO ESRD Network of New England Call for NominationsThe strength of the Network starts with collective leadership. If you or someone that you know is interested in enriching their participation in the ESRD community, please complete the fields below to nominate yourself, a peer, or patient to serve on either the ESRD Divisional Board (EDB) or Medical Review Board (MRB). Duties and responsibilities of each Board can be found at http://network1.esrd.ipro.org/home/about/who-we-are/. Board membership includes representatives from of a variety of healthcare settings and/or disciplines (e.g., dialysis facilities, hospitals, nursing homes, home health) as well as from non-healthcare and information management backgrounds. For example, medical directors, nurse mangers, administrators, social workers, dietitians, technicians, transplant coordinator, vascular surgeons, home therapies staff, statisticians, epidemiologists, medical records managers, medical care/treatment planners, patients (all modalities) and family members/care partners. Board members are elected for a three-year term, with staggered expiration dates to accommodate rotation of new and retiring members.Board members meet at a minimum of four (4) times per year (combination of virtual and face-to-face meetings). Attendance at 75% of meetings is mandatory to retain Board status.Each member is required to sign a Conflict of Interest statement and Affirmation of Agreement with IPRO's Confidentiality, Privacy and Security Policy on an annual basis. Term of office begins December 1, 2017.NOMINATIONS ARE DUE BY OCTOBER 20, 2017** Before you nominate an individual, other than yourself, please get their approval before submitting a nomination. ** Question Title * 1. Please enter contact information for the nominee. Name * Credentials Company/Facility * Address * Address 2 City/Town * State/Province * ZIP/Postal Code Email Address * Phone Number * Question Title * 2. Please select the appropriate role of the nominee. Administrator Data Coordinator Dietitian Nurse Patient / Family Member / Care Partner Physician Social Worker Technician Other (please specify) Question Title * 3. Why should the nominee serve on a Board? Please provide a brief background and summary of experience. Question Title * 4. Please select the Board in which the individual is being nominated. ESRD Divisional Board Medical Review Board No Preference If you have questions, please contact Cheryl Pettway at 203-285-1222 or cpettway@nw1.esrd.net. Done