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2014 AHVRP President-Elect/Board Member at Large Application for terms beginning in 2015

2015 AHVRP President-Elect/Board Member at Large Application - Due April 30, 2014

Thank you for your interest in serving as a member of the AHVRP Board of Directors! We appreciate your willingness to serve.

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* Please mark the position for which you are running:

President-Elect (required to have served at least one year as a current member of the AHVRP Board of Directors)

Board Member at Large

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* Please review the requirements and expectations for the position you are running for before moving forward with this form. Term begins January 1, 2015. Position requirements and expectations can be found in the Call for Leaders packet.

Yes, I have read the requirements and I can fulfill the obligations of this position.

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* THIS INFORMATION WILL BE USED FOR THE ACTUAL BALLOT IF YOU ARE SLATED. SPACE IS LIMITED.

First Name:

Last Name:

Title:

Organization:

Address:

City, State, Zip:

Work Phone:

Fax:

Home Phone:

Email:

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* Enter your supervisor's contact information.

During the reference check process, your supervisor will be required to sign a letter of acknowledgement and support listing the commitments of the position. AHVRP will provide this letter.

First:

Last:

Title:

Work Phone:

Email Address:

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* May the Nominations Committee consider you for another AHVRP position (Board Member at Large or Committee on Nominations)?

Yes

No

Comments:

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* I am interested in being a candidate for this position because (250 words or less)