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* 1. Name:

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* 2. Position nominating for:

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* 3. Email:

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* 4. Phone:

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* 5. Region:

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* 6. How many years have you been an ASCP Member?

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* 7. How have you been involved with ASCP? (Please list all committees, leadership groups, chapter involvement, task forces, etc.)

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* 8. Please list the ASCP meetings (national and regional) you have attended in the past 5 years:

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* 9. Please list other Boards and/or Leadership groups you serve on, and the related organizations/associations:

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* 10. What strengths do you feel you will bring to the ASCP Board?

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* 11. Please tell us a little about yourself, your practice setting, company, and experience:
Why would you like to serve on the ASCP Board of Directors?

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