Committee Application

Consent to serve on an ASA Committee.

Fields marked with an * are required.

Please verify that you have checked the “I'm not a robot” checkbox.

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Personal Information

Consent to Serve

I understand that by consenting to serve ASA in this position I am making a commitment to perform a variety of activities and further agree to carry out all tasks appropriate to the office including, but not limited to, the following.

I will:

  1. Make every effort to familiarize myself with the ASA Bylaws and Policies and Procedures.
  2. Maintain an adequate filing system pertaining to all aspects of my position.
  3. Maintain an open line of communication with national headquarters. Communication is essential to the harmony and effectiveness of ASA business.
  4. Give thoughtful consideration to my efforts when assigned by the President to work on any assignment or special project and will perform those tasks to the best of my ability.
  5. Fully understand that holding a committee position requires a considerable amount of verbal and written communication skills and entails a substantial work effort.
  6. I further agree that if at any time I am unable to serve in this capacity or if I fail in my responsibilities to the Board of Directors, and membership, I will offer my resignation and notify the ASA Board of Directors in sufficient time so that a replacement may be acquired to ensure that committee activities are not unduly interrupted.
  7. I agree, as a committee member, that I will register and attend the ASA Annual Fall Meeting as well as the Spring Joint Conference while on the committee.

**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 committee expectations.

 


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

Bylaws, Policies & Procedures
Membership & Social Media
Workshops
Education and Professional Standards
Budget and Finance
Legislation
Legacy & Organizational Advancement

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ASA Involvement

(Select all that apply)

Executive Board
Board of Directors
Committee Chair
Committee Member
Member

If none, type N/A

Other Involvement

Brief description of any non-ASA, but field related committee or volunteer involvement, including role, duties, and time involved. If none, type N/A.

Brief description of any non-ASA and non-field related committee or volunteer involvement, including role, duties, and time involved. If none, type N/A.

Leadership Questions

How do you hope to contribute to ASA and what specific skills do you posses that will support the selected committee(s)?

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References

Please list three references (name and phone number).

Reference 1 * Reference 2 * Reference 3 *
Additional Documents

Please upload a current resume.

20MB max

Please upload a high resolution photo of yourself for publication.

20MB max