Request to Serve Nomination Form

2017-2018 Program Year

If you or a member of your staff would like to serve on an MHA committee, council or task force, please complete the form below by June 9, 2017.

Membership is determined by many factors, including issue expertise, geographic representation and the size and type of organization. Some groups are accepting a limited number of appointments; however, you should still indicate if you are interested in serving should an opening become available. The MHA makes every attempt to rotate representation and to provide new and interested members with the opportunity to participate.

Please note: If you are currently serving on an MHA committee, council or task force, you will need to complete this form to ensure consideration for the upcoming program year.

Select the committees, councils and task forces on which you would like to serve:

*Currently not accepting appointments, but your interest in serving will be noted should an opening occur.

For more information, contact Andrea Duguay

* Required

Leading Michigan to Better Health

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