Michigan Pharmacists Association Nomination Form

Nominating For: *

Executive Board Position *

MSHP Board Position *

*Please note that MSHP nominations will not be accepted after May 15.

*Please note that Section Board nominations will not be accepted after June 1.

Nominee Information

Name *

Pronouns: *

If other, please list what pronouns are used: *

Practice Site *

Email Address *

Cell Phone Number *

Business Phone Number

Year of pharmacy school graduation

College

Involvement in local or state activities and organizations *

Pharmacy association memberships

Resume or CV:

Nominator's Information

Name *

Phone Number *

Email Address *

Is the nominee aware of your nomination? *

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