OPA Election Nomination Form

JOIN THE LEADERSHIP TEAM
OPA Election Nomination Form
Nominee Name
(First/Middle/Last)
Address
City/State/Zip
Mobile Phone
Preferred Email
Please Check Office. If nominating for District Trustee,
please indicate District number:
Vice president
District Trustee
District #
Qualifications
Current and Past Activity with OPA (offices, committees, meetings, etc.)
 
College and Degree(s) earned
 
Current Position/Company
 
Reasons why you want to serve with OPA leadership
 
What are your priorities/vision for OPA?
 
Other Pharmacy Association Memberships
 
Please submit by September 21, 2017.