HAHIMA Candidate Bio Submission Form

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We must have your consent to serve before we can enter your name and credentials into consideration as a candidate. Completion and receipt of this form signifies your consent to serve.

Thank you for agreeing to run on the HAHIMA ballot.

About the Position

Candidate for*

Demographic Information

Please complete the demographic information below.
Name*
Address*
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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