AMFP Chapter Board Nomination Form

Association of Medical Facility Professionals

1. Nomination Type

Are You Nominating Yourself or Someone Else?

Position Being Nominated For

Complete this section for the person submitting the nomination.

Nominator Full Name

Nominator Email Address

Nominator Phone Number

Submission Date

Full Name

Email Address

Phone Number

AMFP Membership Category

Chapter Affiliation

Summary of professional experience relevant to the role

Past involvement with AMFP

Statement of interest and vision for AMFP

Resume/CV and Letter of Recommendation are optional. PDF files only, maximum 10 MB each.

Resume or CV (Optional)

Letter of Recommendation (Optional)

Conflict of Interest, if any

Acknowledgment

Signature

Date