Board Application

I would like to serve on the WHPRMS Board of Directors in the following position:*
- President Elect
- Secretary
- Treasurer
- Membership Chair
- Education Chair
- Awards Chair
- Events Chair
- Social Media Chair
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone*

Volunteer
Membership/afﬁliations other than WHPRMS (please list organization/role/dates):
Leadership positions held other than WHPRMS:
Professional awards/honors received:
Service awards/honors received:
Past WHPRMS involvement (please list committee assignments, special projects, etc.):
Member of WHPRMS since:*

Please attach a brief summary (not to exceed one page) as to why you would like to serve on the WHPRMS board of directors. All applications must include this summary to be considered.
Summary*
Max. file size: 50 MB.
I’ve read the WHPRMS bylaws and am willing to serve pursuant to them, and will accept the time obligations as a board member.*
I’ve read the WHPRMS bylaws and am willing to serve pursuant to them, and will accept the time obligations as a board member.
- I agree
Phone
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Employment