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SePHIMA Candidate Bio Profile Submission Form

CLICK HERE to review the description of the duties and guidelines.

Items you include will be used to determine your eligibility. This information will also serve as the basis for your CV that will be available on the SePHIMA web site. You will be contacted to verify/approve your final CV.

If elected, you will be required to attend the SEPHIMA Board Meeting in May/June.

"*" indicates required fields

About the Position

Candidate for*
Are you an active SePHIMA member?*

Demographic Information

Please complete the demographic information below.
Name*
Address*

Photo

Max. file size: 256 MB.

Employment

Current Employment
Provide job title and company name in reverse chronological sequence of positions held the last 10 years.

Education

Show degrees earned, dates, names of college or university.

Volunteer Activities

List any additional information that would be of value or assist in supporting your candidacy.
This field is for validation purposes and should be left unchanged.