November 8, 2017 - Election Ballots Distributed to IACP Membership. December ... (Missouri, Kansas, Michigan, Nebraska,
NOMINATION FORM Candidates for the IACP Board of Directors 2017 Elections IACP needs YOU! YOU are instrumental to the success of IACP and to compounding. Please consider joining the IACP Board of Directors today! If you are interested in submitting your name or the name of a colleague as a potential candidate to the 2017 Nominating Committee, simply complete both sides of this form and return it to IACP no later than October 26, 2017. Your form may be sent via FAX to (763) 788-0578, or via e-mail to
[email protected]. Following approval of the slate by the IACP Board, ballots will be available to IACP members in November. Important Dates September 12, 2017 - Open Call for Nominations October 26, 2017 - Nominations Closed November 6, 2017 - Report of the Nomination Committee November 8, 2017 - Election Ballots Distributed to IACP Membership December 15, 2017 - Elected Position Winners Announced to Membership Please feel free to contact IACP with questions regarding the nominating process at (281) 933-8400.
CONTACT INFORMATION Name of Nominee ______________________________________________________________ Mailing Address ________________________________________________________________ City ____________________________________ State________________________________ Country and ZIP/Mailing Code _____________________________________________________ Daytime Telephone Number _______________________________________________________ e-Mail Address _________________________________________________________________ I am a
Pharmacist
Technician
Other Professional
(Please check one)
PROFESSIONAL SERVICE INFORMATION I have served IACP:
As a current or past member of a committee. As a past member of the Board of Directors. As a current or past member of an IACP Foundation committee. As a past member of the IACP Foundation Board of Directors.
I have served my state association: As a current or past member of a committee. As a past member of the Board of Directors. Name of state association ______________________________ ©2017 International Academy of Compounding Pharmacists. All Rights Reserved
I have served another national association:
As a current or past member of a committee. As a past member of the Board of Directors. Name of national association ______________________________
BOARD POSITION OF INTEREST I am submitting my name in consideration for the following Board of Directors’ seat(s): (Please check one or more)
Vice President
One seat for a one-year term expiring December 31, 2018. The Vice President automatically becomes the IACP President-Elect and then IACP President. Nominees must be a current or past Board member who have served at least one year on the Board.
District III
One seat for a one-year term expiring December 31, 2018 (Ohio, Indiana, Illinois, Virginia, West Virginia, Kentucky, North Carolina, South Carolina)
District IV
One seat for a three-year term expiring December 31, 2020 (Florida, Georgia, Alabama, Mississippi, Arkansas, Tennessee)
District V
Two seats for a three-year term expiring December 31, 2020 (Louisiana, Texas, Oklahoma, New Mexico)
District VI
One seat for a three-year term expiring December 31, 2020 (Missouri, Kansas, Michigan, Nebraska, Iowa, North Dakota, South Dakota, Minnesota, Colorado, Wyoming, Montana, Utah, Wisconsin)
District VII
One seat for a three-year term expiring December 31, 2020 (Arizona, Nevada, California, Oregon, Washington, Idaho, Alaska, Hawaii)
NOMINEE STATEMENT In no more than 75 words, please tell the Nominating Committee and the membership at large why you believe you or your colleague would be a worthy addition to the IACP Board of Directors. You may use the space provided below or submit your statement under separate cover along with this form. ________________________________________________________________________________
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©2017 International Academy of Compounding Pharmacists. All Rights Reserved
