Candidate Profile Form

	Volunteering for NCRA is a great professional development opportunity! NCRA is looking for volunteers for the following leadership positions: Governance, Planning and Evaluation Committee (GPEC) - Three positions are open for GPEC: (One Position) GPEC Term: June 2023-May 2024 (Two Positions) GPEC Term: June 2023-May 2025 2025 Annual Conference Program Committee- Term: June 2023-May 2026 Medical Registry Committee Chair- Term: June 2023-May 2025 Social Media Committee Chair- Term: June 2023-May 2025 To apply for the positions please complete the candidate profile form below. Deadline is June 11, 2023. Information about each of the positions is available on NCRA’s website: http://www.ncra-usa.org/Membership/Volunteer

1.

Please provide your contact information:

Name:
Company:
Address 1:
Address 2
City/Town:
State/Province:
ZIP/Postal Code
Country:
Email Address:
Phone Number:

*2.

Check all volunteer positions that are of interest to you and rank them according to preference with 1 being your first choice. If you are not interested in applying for a position, mark with a zero.

Please rank all items using values 1 to 5. Use each value only once.

GPEC Term June 2023-May 2024
GPEC Term June 2023-May 2025
2025 Annual Conference Program Committee Chair
Medical Registry Committee Chair
Social Media Committee Chair

3.	What is your current occupation:

4.	Please indicate other job related experience relevant to your application:

	Remaining characters: 1000

5.	Please list your education/degrees and credentials:

	Remaining characters: 500

6.	Please describe your NCRA volunteer or leadership history:

	Remaining characters: 500

7.	Please list other professional/association volunteer or leadership history:

	Remaining characters: 500

8.	Please describe your leadership skills and other knowledge that enable you to hold the position(s) for which you are applying:

	Remaining characters: 1000