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* 1. Member contact information

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* 2. Select your TOP 3 choices for SHSMD involvement. Refer to  2021 volunteer opportunities for details. We will do our best to accommodate your interests based on availability and team size. (SELECT UP TO 3)

  First Choice Second Choice Third Choice
Conference Planning Committee
Conference Moderator / Introducer
Beta Tester
Bridging Worlds and SHSMD ADVANCE Contributor
Digital Engagement Contributor
Education and Editorial Advisory Board
Executive Strategies Task Force
New Member Engagement Task Force
Member Mentor Volunteer
Microvolunteering
Recognition Committee
Volunteer Writer / Story Teller
Not interested

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* 3. In a few words, please describe your ideal volunteer experience with SHSMD:

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* 4. Indicate your years of experience in the following areas:

  Under 5 years 6-10 years Over 10 years
Years in a health care strategy discipline (i.e., planning, marketing, communications, business development, etc).
Years in strategy role OUTSIDE of health care
Years in leadership role (director or above)
Years in SHSMD membership

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* 5. In your current role, what is your level of responsibility? (SELECT THE BEST ANSWER.)

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* 6. In your current role, what is your primary job function? (SELECT ONE)

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* 7. In your current role, what is your secondary job function? (SELECT ONE)

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* 8. What are the 3 strengths you could bring as a project volunteer? (SELECT ONLY 3)

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* 9. Provide any additional information about your background that may be useful to your SHSMD volunteer role

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* 10. In the PAST 5 YEARS, how many times have you...(SELECT ONE RESPONSE PER ROW)

  0 1-2 3-4 5 or more
Volunteered to serve a SHSMD committee or task force?
Served on a SHSMD committee or task force?
Been nominated to the SHSMD board?
Attended the SHSMD Connections annual conference?
Presented at annual conference or SHSMD Education?
Contributed an article or blog?
Participated in an online discussion (MySHSMD)?

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* 11. What is your highest degree earned? (SELECT ONE)

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* 12. Which of the following recognition's have you received? (SELECT ALL THAT APPLY)

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* 13. What is your organizational affiliation? (SELECT THE BEST ANSWER)

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* 14. What is your organization's locale?

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* 15. Do you plan to attend the SHSMD Connections 2021 Annual Conference in San Antonio September 19-21, 2021?

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* 16. OPTIONAL: Based on your birth date, which generational cohort are you a member of:

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* 17. OPTIONAL: Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

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* 18. OPTIONAL: Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

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* 19. If asked to serve, I am confident I will meet the time commitments described in the leadership opportunities and will actively contribute to the achievement of committee or project objectives

T