Consent to Serve Form

All candidates for positions on the NAP Board of Directors and the Commission on Credentialing must submit this completed form prior to the election.

Candidate's Name(Required)

First Last

Position sought(Required)

I am currently (select one)(Required)

a credentialed member (RP or PRP)

a regular member

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

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