Election Nomination Form

JOIN THE LEADERSHIP TEAM
OPA Election Nomination Form
Nominee Name
(First/Middle/Last)
Address
City/State/Zip
Day-time Phone
Please Check Office. If nominating for District Trustee,
please indicate District number:
Vice president
Executive Committee Member-At-Large
District Trustee
District #
Qualifications
Qualifications
 
If possible, email resume to abennett@ohiopharmacists.org
Reasons why nominee would make a good candidate
 
Past activity in OPA
 
Name of member submitting nomination (First/Middle/Last)
 
Date
Nominators Preferred Email Address
Please submit by September 25, 2014.