First Name *

Last Name *

Phone *

Email *

Consent to Serve *

By accepting a position with the Association of Surgical Assistants (ASA), I acknowledge that I am making a commitment to actively serve the Association and fulfill the responsibilities of my elected or appointed office. I have read and understand the duties and expectations of Board service and agree to carry out all responsibilities associated with the position, including but not limited to the following:

1. Read, understand, and uphold the ASA Bylaws.
2. Maintain open and professional communication with ASA members, the Board of Directors, and the          Executive Committee.
3. Recognize that statements made in public or professional settings may be interpreted as representing the official position of the Association.
4. Understand and comply with reporting requirements and deadlines for assigned committees and Board responsibilities.
5. Complete assigned tasks and projects in a timely, professional, and collaborative manner.
6. Acknowledge that serving in an elected or appointed leadership position requires a significant commitment of time, effort, and effective written and verbal communication.
7. Respond to emails and other Board communications promptly and professionally, recognizing the importance of timely collaboration and decision-making.

I further agree that, if at any time I am unable to fulfill the duties of my position or fail to meet my responsibilities to the Association of Surgical Assistants, its Board of Directors, or its membership, I will promptly submit my resignation and notify the Board with sufficient notice to allow the vacancy to be filled without disrupting the work of the Board or its committees.

I understand that if I do not voluntarily resign under such circumstances, I may be removed from office by a two-thirds vote of the Board of Directors, in accordance with the Association’s Bylaws.

**This consent to serve form will be discarded two years from date of receipt. If after that time you remain interested in working with ASA, you must submit a new consent-to-serve form and curriculum vitae.**

By selecting "Yes", it constitutes a legal signature confirming that I acknowledge and agree to meeting expectations.

Enter required value Yes No

Consent to Serve *

I do hereby consent to serve the Association of Surgical Assistants (ASA) in the capacity of (select only one):

President

Vice President

Treasurer

Secretary

Director

Number of Years in ASA *

Positions Held Within ASA *

(Select all that apply)

Executive Board

Board of Directors

Committee Chair

Committee Member

Member

References *

Please list three references (name and phone number).

Reference 1 *	Reference 2 *	Reference 3 *
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Resume *

Please upload a current resume.

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Headshot *

Please upload a high resolution photo of yourself for publication.

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Election Statement *

Please upload an election statement for publication.

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