NCPA Candidate Information Form

Please complete this form to submit your nomination for your candidacy prior to the Annual Business Meeting on August 12, 2023. Candidates will be posted on the NCPA website for member review.

First name

Last name

Mobile

Office Name

Chiropractic School Attended

Years of Practice

Years NCPA Member

Professional Affiliations or Additional Education Credentials

Position Running For

Previous Positions Held within the NCPA (if any)

Why are you interested in serving on the NCPA board?

How do you plan to contribute to the growth and development of the NCPA?

Please share any other information you feel is relevant for voters to know about you

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