SIIM Board of Directors Nomination Submission Form

SIIM Board of Directors Nomination Submission Form

Submitter Name*

Today's Date*

Submitter Email Address*

Is this a self-nomination?*

Select or enter value

Nominee Name*

Nominee Employer*

Describe why this person is an ideal candidate who demonstrates passion for advancing imaging informatics and has a deep commitment to SIIM.*

Send me a copy of my responses

Powered by

Privacy Notice|Report Abuse