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APPLICATION FOR ELECTIVE OFFICES

Please complete all sections of the form in a concise manner. The intent of the questions is to gain valuable insight into each candidate's qualifications. Your responses will be utilized by the Nominations Committee in the selection of the final slate of nominees for elected offices.

Please select the Offices for which you would like to be considered: *
President-elect
Board of Director
Secretary
Treasurer
Nominees Name *
Nominees Home Address *
Nominees Business Address *
Nominees Daytime Phone Number *
E-mail Address: *
Employment History/Academic Appointments *
Please describe current employment position and responsibilities *
Education and Training (list degrees, certificates, and granting institutions *
List Employment/Academic Committee Involvement *
Describe your involvement with ABHP to date *
Describe other Professional Association/Academic activities (state, local, or national) *
List any awards, honors, or special organizational memberships *
List or describe any Community Service activities *
List any publications, presentations, or research activities *
What issues have you identified as being most critical to the future practice of pharmacy? How have you addressed these issues in your practice? *
What issues have you identified as being most critical to the ABHP? *
Cite examples of significant contributions you have made through other organizations and/or through your involvement with ABHP. *
Briefly describe what qualifies you for this nomination (cite specific qualities) *
Attach the Nominee's CV or Resume
* Required
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