Ohio-ACC Board of Trustees Election: Nomination Reply Form Information

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Please complete each field with your information EXACTLY the way you would like it to appear on the ballot. (Note: Neither your email nor your cell phone will appear on the ballot.)

Email *

Expectations of an Ohio-ACC Trustee

https://www.ohioacc.org/wp-content/uploads/2020/05/OH_Role_of_BOT_Member.pdf

First Name *

Middle Initial

Last Name *

Designation (e.g. MD, FACC; DO, FACC, etc.) *

Name of Hospital/Institution *

City *

Cardiovascular Specialty: *

Please provide a brief statement (no more than 200 words) describing your qualifications and why you would like to be the Ohio-ACC Board rep from your institution. Please note this statement will be provided on the ballot. *

Cell phone *

Comments

I have read the Expectations of Trustees (https://www.ohioacc.org/wp-content/uploads/2020/05/OH_Role_of_BOT_Member.pdf) and agree to have my name placed on the ballot if approved by the nominating committee. *

I agree.

Required

Send me a copy of my responses.

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