2007 Nmpha Annual Conference Scholarship

2017 NMPHA CANDIDATE NOMINATION FORM

The New Mexico Public Health Association (NMPHA) shall elect candidates for open positions for office in April 2017. Any person who has been a member of the Association for a period of at least one year is eligible to place his/her name in nomination for office.

Nomination Forms are due by February 19 , 2017 .

Each candidate is required to submit a written statement describing his/her previous experience with NMPHA, reason(s) why he/she is seeking office, and his/her vision for the organization. These statements will be provided to the members along with the official ballot, sent by email to all current NMPHA members in early March 2017.

Voting by secret ballot will then take place at the Annual Conference on April 5, 2017, with results announced at the annual awards luncheon on April 6, 2017. Members unable to attend the Annual Conference will be offered an alternative absentee ballot process to place their vote.

The following NMPHA positions are currently open for election. Please check the office for which you are placing your name in nomination (please check only one):

President-Elect (indicate if running as Co-President-Elect and with whom) Treasurer NW Region (Counties of Cibola, McKinley, San Juan) SE Region (Counties of Harding, Quay, Curry, Roosevelt, Lea, Eddy, Chaves, De Baca)

Please complete the following information:

Name: ______

Job title and current employer: ______

Address:______

______

Phone:______Fax: ______Email:______

Please answer the following questions. Attach additional sheet(s) if necessary.

1) How are you involved in public/community health? 2) Please describe your activities and involvement with the New Mexico Public Health Association.

3) Why are you interested in seeking this NMPHA elected position?

4) Please describe your vision for the future of NMPHA as an organization.

I certify that all statements made above are true and correct.

Signature______Date______

Return your completed nomination form as an email attachment (typed signature accepted) to Courtney FitzGerald ([email protected]) or Jessica Reno ([email protected])

Nominations must be received no later than February 19 , 2017 .