Please submit your application by January 22, 2012.
Name:
Job Title:
City:
State: --select-- Delaware New Jersey New York Pennsylvania
Email:
Phone:
Library Name:
Type of Library:
Academic Hospital Public Other If other, please specify:
Academic Hospital Public Other
If other, please specify:
Which committee are you interested in serving on? (Info for Regional Advisory Committee or Special Advisory Groups)
Regional Advisory Committee Outreach to Health Professionals & Public Health Workers SAG Consumer Health SAG Hospital Libraries SAG Resource & Academic Libraries SAG
Please give us a brief statement of your experience and interest for serving on the RAC or a SAG:
