ACDIS June call for volunteers—boards and committees

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

Please note that after you complete question 7, you will be directed to another page with the application for the particular committee for which you're applying. Please fill out all requested fields to be considered for committee service.

At the end of the survey, you will have the ability to indicate any other committees you're interested in serving on.

Please note that the ACDIS Events Committee and the Furthering Education Committee are not open to vendors or consultants as ACDIS tries to ensure transparency and unbiased selection for events and awards.

Question Title

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

First Name *

Last Name *

Credentials *

Address

City/Town *

State/Province *

ZIP/Postal Code *

Company/Organization *

Email Address *

Phone Number *

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

Provider

Consulting

Other (please specify)

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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.)

Yes

I don't know

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

PDF, DOC, DOCX file types only.

Choose File

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* 6. All positions require volunteer hours during traditional 8 a.m. to 5 p.m. work hours. Have you obtained permission from your direct manager/supervisor to participate in meetings, email correspondence, and other like responsibilities?

Yes