SCACM Willingness To Serve Form

Volunteer for the SCACM Board

Complete this form if you wish to take your clinical microbiology networking to the next level by teaming up with strong microbiologists from across seven states to provide high quality education to our lab teams.

Question Title

* 1. Today's Date

Date

Question Title

* 2. Name and Home Address

Name: *

Home Address:

Home Address 2:

Home City:

Home State:

Home ZIP:

Home Phone Number:

Question Title

* 3. Work Address

Company Name:

Work Address:

Work Address 2:

Work City:

Work State:

Work ZIP:

Work Phone Number:

Question Title

* 4. Preferred Address

Home

Work

Question Title

* 5. Email

Email Address:

Question Title

* 6. Area of Interest/Expertise?

Question Title

* 7. Preferred Contact

Please contact me at my HOME PHONE

Please contact me at my WORK PHONE

Please contact me at my EMAIL

I'll stop at the Spring Meeting registration table to get more info

If contact by phone, list best days/times to reach you

Question Title

* 8. Committees- get involved with teams of volunteers to run various board operations (check all that apply)

Audiconference

Awards

CEU

Corporate Liaison

Exhibits/Sustaining Membership

Fall regional Meeting Planning

Historian

Information Technology

Nominations

Program Planning (Spring)

Public and Professional Affairs

Publications (Newletter)

State Directors Coordinator

Workshops (Planning. Presenting)

Question Title

* 9. Interest Group- select an areas (check all that apply) and then coordinate one lecture, repeated twice at our Spring Meeting

Antimicrobial Agents

General Bacteriology

Management, Supervision, QA and Computers

Molecular Diagnostics, Virology, & Serology

Mycobacteriology, Mycology & Parasitology

Interest Group Coordinator- manager of all the leaders above

Question Title

* 10. Elected Positions- take on our higher-levels of leadership

Secretary- take notes of our meetings

Treasurer- handle our accounting for our board

State Director- coordinate a Fall Meeting in your state

Director at Large (must have already been on the board for at least two years)- mentor new board members and help with board decisions

President-Elect (must have already been on the board for at least two years)- manage the board