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
 
Vice President candidates must provide a statement of intent, 100 words or less.
Statement of Intent
Please submit by September 19, 2019.