TSSCVPR Board of Directors/Committee Chair Nomination Application

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Thank you for your interest in joining or nominating someone to join the TSSCVPR Board! See attached for a brief description of the duties/responsibilities of each board position. All applicants and/or nominees must be a current TSSCVPR Joint Affiliate member to apply. Each position is a 1-year commitment, except for the treasurer which is 2 years. Please complete the following application to nominate yourself or a colleague.

Are you applying for yourself or nominating someone? *

Applying for myself

Nominating someone

Name *

Email *

Address

Phone number *

Employer Name *

Employer Address/Phone

Current Position/Credentials (ie RN, CEP, RRT) *

Years of Experience *

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