SOMA Call for Board Applications

SOMA Call for Board Applications

Submitted form will automatically be sent to:
SOMA
111 W. Jackston Blvd., Ste. 1412
Chicago, IL 60604
(913) 222-8659
info@specialoperationsmedicine.org

Step 1: Please read the Call for Board Applications (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
SOMA Participation

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:

SOF Qualifications or SOF Service

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 SOMA 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) 222-8659.

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.