ITLS 2018-2019 Committee Application

Are you interested in getting more involved with ITLS? Apply to serve on a committee!

Committee applications are due August 15, 2018. You will receive notification of committee appointments in mid-September. Placement is at the discretion of the ITLS Board of Directors and Committee Chairs and Co-Chairs.

Before submitting your application, please review the ITLS Committee 2018-2019 Rules

Not sure what to apply for?
View Committee Listing & Mandates

(Mandates subject to change for 2018-19 cycle)

1. First Name: *This question is required.

2. Last Name: *This question is required.

3. Credentials (MD, RN, EMT-P, etc.) *This question is required.

4. Email: *This question is required. This question requires a valid email address.

5. Preferred Phone Number: *This question is required.

6. ITLS Chapter/Training Centre: *This question is required.

7. Do you have the support of your Chapter/Training Centre for this appointment? *This question is required.

8. What is your ITLS role? (Please check all that apply) *This question is required.

Medical director
Chapter administrator/coordinator
Course coordinator
Instructor
Provider
None
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

9. Are you currently serving on an ITLS committee? *This question is required.

10. On which committee(s) are you currently serving? *This question is required.

10. Do you wish to serve on any committees for the 2018-2019 cycle?
(If yes, you will specify your preferences in the next question) *This question is required.

Please rank your top 3 committee choices in order from most interested to least interested:

Appointments to the Finance Committee, Editorial Board, and Editorial Board Workgroups are determined by the ITLS Board of Directors and/or ITLS Editorial Board. You will be notified if you have been invited to one of these committee for 2018-2019.

11. Describe your prior involvement and experience with ITLS committees and/or your ITLS chapter/training centre: *This question is required.

11. What do you feel you could contribute as an ITLS committee member? *This question is required.

11. Please describe any potential conflicts:

11. Application Attestation *This question is required.

By checking this box, I attest that the above information is true.