Nomination Form – Arizona Society for Respiratory Care

Positions with a >1 year term

Vice President (1 year term, then become president for 2 years)
Board Member (2 Year Term, 2 Vacant)
Delegate (4 Year Term)
Treasurer (2 Year Term)
Secretary (2 Year Term)

One Year Positions

Student Member (non-voting)
Public Member (non-voting)
Military Liasion (non-voting)

The term length is one year for all the above positions.

Nominee Information

Name *

First

Last

AARC ID

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Signature *

I am an AARC member in good standing. I hold a current Arizona Respiratory License and do not have any board actions on record. I understand that as an AzSRC Board member, I must set an example for others in the profession. If an action is placed on my record and I am elected to the AzSRC Board, I will rescind my elected position and remove myself from the board and board activities. My typed full name represents an electronic signature and an agreement to this statement.

Biography Information

This is the information that will get posted on the website.

Credentials/Degree Held *

AARC/AzSRC Tenure (if any)

Current Place of Employment *

Current Position Held *

Past & Present AzSRC Activity (if any)

Education *

Nominee's Reason/Interest for Position *

What does it mean to be an AARC/AzSRC member? *

Picture Upload *

Allowed file formats: jpeg, png, jpg, gif

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