The purpose of this form is to allow you to share information about chapter members who serve on any official governmental advisory boards, medical boards, or who are elected officials. Additionally, by submitting this form you earn ten points for your chapter towards the Chapter Recognition Award in Government Relations.
Instructions:
Please complete the entire form and click "Submit" when finished. Your responses may be shared with other chapter leaders and ACR staff.
If you have questions about this form please contact the ACR Office of Chapter and Volunteer Development at (800) 401-1438 or at chapters@acr.org. |
| Name |
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| Chapter |
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| Position in Chapter |
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| E-mail Address |
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| Telephone Number |
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| 1. Name of chapter member holding a position. |
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| 2. Name of the governmental advisory board, medical board or elected office. |
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| 3. Please describe the role the person plays. |
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| 4. Did your chapter recommend the person's appointment or election? |
| Yes No |
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