APhA House of Delegates Committee Application

Please provide the following information to be considered for a APhA House of Delegates committee.

Note: We ask that you upload your CV / resume at the end of this form or submit via email to: hod@aphanet.org.
Thank you for your interest in serving on an APhA House Committee!

Which of the following committees would you have an interest to serve on?
                                               (Please select all that apply.) *
Indicate the practice setting(s) you currently practice within and those that you have experienced practice:
 Currently Practice InHave Practiced In
Independent Pharmacy
Chain / Supermarket Pharmacy / Mass-merchant Pharmacy
Hospital / Institutional Pharmacy
Clinic-based Practice / Ambulatory Care
Long Term Care Pharmacy
Mail Service Pharmacy
Pharmaceutical Industry
Pharmacy Law
State Board of Pharmacy
Federal / Military Pharmacy
Managed Care Pharmacy
Association Management
Home Health Care
Nuclear Pharmacy
Please Indicate the delegation(s) you have represented within the House of Delegates in the past:       (Select 1 or more options)
Indicate the number of years you have served as a Delegate to the House of Delegates:
Committee members are expected to participate in various committee conference calls and meetings throughout the year as scheduled by the APhA Speaker of the House and the Committee Chair.  While not required, committee members are highly encouraged to attend both House sessions to support and provide feeback to colleagues.  Note:  It is the responsibility of the committee member to secure his/her seat as a Delegate to the APhA House of Delegates.

Affirmation:  I have read and understand the Committee Charges and Responsbilties (provided in the link on the first page of this application).  As a House of Delegates committee member, I am prepared to commit the time required to fulfill my responsibilties. *

Deadline for submissions is 5pm (Eastern) on Wednesday, May 17, 2017.
If you have questions regarding the APhA House of Delegates, committees, or committee responsibilities, please contact APhA staff at hod@aphanet.org.
Thank you for your interest in serving the 2018 House!