Perinatal Equity Committee Chair and Vice Chair Nomination Request

Thank you for taking the time to complete our nomination form. We look forward to connecting with the applicant (we welcome both self-nominations or associates) in the near future to share the next steps! 
1.Name, Occupation, Place of Employment
2.What position are you interested in?
3.Please give us a brief description of your interest in this position and why you would be a good fit.
4.Contact information: Email address, phone number
5.Thank you for your nomination! Please let us know if you have any further questions.