Tennessee Pharmacists Association | Candidate Information Form - TPA and Societies

Thank you very much for your willingness to serve as a TPA or Society leader! Please provide the information requested below BY WEDNESDAY, MARCH 31, 2021. If you have questions, please contact Lisa Hull at lisa@tnpharm.org or 615-256-3023, ext. 1000.

* = Required Field

I AM A CANDIDATE FOR OFFICE IN THE...*

I AM A CANDIDATE FOR...*

NAME*

Enter your name as you wish it to it appear on the ballot and (if elected) your press release.

First Last

PHARMACY CREDENTIALS*

TECHNICIAN CREDENTIALS

HOME ADDRESS*

Street Address - Line 1 Street Address - Line 2 City State Zip Code

CURRENT EMPLOYER*

TITLE*

WORK ADDRESS*

Street Address - Line 1 Street Address - Line 2 City State Zip Code

YEARS WORKED FOR CURRENT EMPLOYER*

HOME PHONE NUMBER*

WORK PHONE NUMBER*

CELL PHONE NUMBER*

PREFERRED EMAIL ADDRESS*

PHARMACY SCHOOL/COLLEGE, DEGREE, and GRADUATION YEAR*

List any that apply.

FORMAL PHARMACY TECHNICIAN TRAINING and YEAR COMPLETED

List any that apply.

RECENT WORK HISTORY*

PLEASE INCLUDE YEARS.

PROFESSIONAL INVOLVEMENT IN TPA AND/OR TPA SOCIETIES*

Include offices held, honors, awards... anything else!
PLEASE INCLUDE YEARS.

OTHER ASSOCIATION OR PROFESSIONAL INVOLVEMENT*

Include offices held, honors, awards... anything else!
PLEASE INCLUDE YEARS.

CIVIC AND COMMUNITY INVOLVEMENT, FAMILY, ETC.*

PLEASE INCLUDE YEARS if applicable.

STATEMENT OF GOALS/ISSUES*

THIS IS ONE OF THE MOST IMPORTANT THINGS! In brief (3 to 5 sentences), describe what you think the major goals/issues are for TPA or your society, as well as for the office. This Statement will appear on the ballot, along with your name, photo, and bio.

PHOTO

Below, please upload a high-resolution photo of yourself. The photo will appear on the ballot, along with your name and Statement of Goals/Issues.

If you have any difficulty uploading your photo, please email it to lisa@tnpharm.org.

Drop files here or

Max. file size: 256 MB.

Candidate Information Form – TPA and Societies