Welcome to the Desire to Serve Elected Positions Form

By completing and submitting this form, you are indicating to your colleagues that you wish to be considered for leadership opportunities within the California Pharmacists Association (CPhA).

Information submitted will be reviewed by the CPhA Elections Committee and utilized to determine the best candidates for elected positions within the California Pharmacists Association. We encourage all applicants to review the CPhA Strategic Plan as a guide to the organization's vision.

With this form, you can submit an application for:

President-Elect: Requires a three-year commitment, one year as President-Elect, one year as President, and one year as Past President
Trustees at Large: Requires a three-year commitment
**Speaker-Elect: Requires a two-year commitment, one year as Speaker-Elect, one year as Speaker (voted on at the House of Delegates)
Student Trustee: Requires a one-year commitment
SIG Chair-Elect: Requires a two-year commitment, one year as Chair-Elect, and one year as Chair

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone *

Email *

Which category describes your membership category within CPhA? *

Other (specify) *

Which CPhA Local Chapter(s) are you affiliated with? *

What is your primary practice setting? *

Other (specify) *

Select the elected position(s) that interest you.

President-Elect (3-year commitment: 1-year term as President-Elect, 1-year term as President, 1-year term as Immediate Past President)

Trustee-at-Large (3-year term)

** Speaker-Elect (2-year commitment: 1-year term as Speaker-Elect, 1-year term as Speaker - Voted on at HOD in September)

Student Trustee (1-year term)

For those seeking to serve as Chair-Elect of a Special Interest Group (SIG) select the SIG(s) you wish to be considered for. For a description of our SIG(s), click here.

The next few questions will provide the Elections Committee with information about you. Provide examples, perspective and any information that can be used to provide the reason for your wishing to serve as a leader in CPhA.

List your prior appointed and elected positions you have held with CPhA and other pharmacy related associations. *

What other leadership and/or volunteer experience do you have that would be valuable in the position(s) you are seeking? *

Upload all required files including CV/resume (required) and a letter of recommendation (should you desire to provide one).

CV/Resume *

Professional Headshot *

Letter of Recommendation (optional)

If you are slated on the ballot, CPhA will publish your professional biography on the official ballot. Provide your 1-2 paragraph professional biography highlighting your role as a pharmacy professional. (You will have the opportunity to edit this professional biography, if slated) *