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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
Email
Mobile
Office Name
Chiropractic School Attended
Years of Practice
Years NCPA Member
Professional Affiliations or Additional Education Credentials
Position Running For
-- Please Select --
Omaha District
Western District
South Central District
Central District
At Large
Peer Review Position 1
Peer Review Position 2
President Elect
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
Submit
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