NASPOG Board Application

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* 1. Contact information:

Full Name and Credentials

Current (Active) Practice/Employer

Email Address

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* 2. Select your professional category:

OB/GYN

Psychiatrist

Psychologist

Nurse

Social Worker

Licensed Professional Counselor

Other (please specify):

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* 3. Years in Practice:

1-4

5-10

11-15

16-20

20+

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* 4. Select which Board position you are applying for:

President-Elect

Secretary-Treasurer

Member-at-Large (3 positions available)

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* 5. Interest Statement: State your interest in serving on the NASPOG Board:

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* 6. Highlight any previous organizational leadership and/or NASPOG volunteer experience.

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* 7. The mission of NASPOG is to promote the study and clinical application of the neurobiologic and psychosocial aspects of women’s health and well-being across the life span. Comment on how you personally plan to move this mission forward.

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* 8. State an issue that our members are facing today and how you plan to address it through leadership in NASPOG.

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* 9. Upload your CV or Resume

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.