Open Call: Local Sections Advisory Group Member

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* 1. Name of Nominee and Contact Information

Name

Company

State/Province

Email Address

Phone Number

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* 2. Briefly share what experience or engagement you have had with AIHA local sections?

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* 3. Briefly state why are you interested in serving on the Local Sections Advisory Group?

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* 4. What do you hope to accomplish as a member of the LSAG?