Name:
Home Phone: Work Phone:
Home Email: Work Email:
Professional Designation/ Certifiction(s):
Board Position Applying For:
President Elect (3 Year Term) (1 Position Available)
Treasurer (currently occupied)
Secretary (currently occupied)
Board Member (3 Year Term) (2 Positions Available)
Educational Background:
Number of Years in Case Management:
Number of Years as a CMSA member:
Past and Current Involvement in CMSA:
Vision for CMSA of the Chesapeake:
CMSA of the Chesapeake Board of Directors Form
Thank you for your interest in serving on the board of directors. Please complete the form below and click on the submit button when done. Final date of submission is to be announced. You may also download the paper forms (found on the left) and mail.
If you are sending your application by mail, please mail applications to:
CMSA of the Chesapeake
P.O. Box 1816
Millersville, MD 21106
