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NAEMSP application for nomination for
Board of Directors
NAEMSP Logo



Submitted form will automatically be sent to:
NAEMSP Executive Office
4400 College Boulevard, Suite 220
Overland Park, KS 66211
913-222-8654, 800-228-3677 · Fax: 913-222-8606

Step 1: Please read the Candidate Criteria instructions (PDF).

Step 2: Please enter the following information, then click the "Confirm" button at the bottom of this page:
         
Nomination for:
Name:
  First Middle Last Credentials/Degrees
 
Position/Title:
         
Institution:
         
Address:
  Street City State Zip Code
         
E-Mail: Office Telephone: ()-  
         


Qualifications

NAEMSP Participation. (List present to past):

Length of membership: years

Board positions held and year(s) served (please limit your entry in this and all subsequent text boxes to a maximum of 1500 characters each):


Committee(s), position(s) and year(s) served:


Professional Experience. (List present to past) Job Title, Institution, City/State, and date(s) of employment:


Experience in field: years

Education. (List present to past) Degree(s) earned and date(s):


Professional Activities. (List present to past):


Personal Statement. Please direct your statement to the nominating committee. If nominated, you will be
given the opportunity to produce a statement to the membership for election purposes:






Consent. I verify (or have verified with the proper party) willingness to serve on the NAEMSP Board of Directors.

Signed (enter you full name here): Date:

Receipt of this Recommendation Form will be acknowledged via e-mail within two (2) business days of receipt in the Executive Office. If an acknowledgement is not received within this time frame, please contact the Executive Office at 913-222-8654, 800-228-3677.

Please note that a recommendation/nomination does not guarantee that the person's name will appear on the slate.  Self nominations are permitted.

'Security' question - what color is the sky (four letters, starts with b):

 

 

 

 

 


Electronic voting provided by Vote-Now.com.