NMCTM Application for Regional Representative
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Enter member email
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Please ensure that you enter the email address correctly or the member will not receive their certificate.
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What is your first name?
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Please make sure to user proper punctuation and spacing.
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What is the member's last name?
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What region are you applying for?
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Southwest
Southeast
Central
Northeast
Northwest
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What is your present position, title, etc.?
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Please list the last three professional presentations, workshops, or other professional leadership work that you have done (including your own site or conferences, workshops, etc.).
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Please provide a brief list of your professional experience.
After you finish this form, please email your curriculum vitae / resume to
president@nmctm.org
.
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Briefly describe what you wish to accomplish in your NMCTM leadership role
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Please tell us any additional information you would like to share with the membership.
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