X12 Board of Directors Application Form

The deadline for applications for a 2019-2021 term: November 12, 2018. You must complete the form in one session.

Fields Marked with a * are required
* Name
* Email
* The applicant and the company listed above understand the time and resource commitment required and supports my application for a board position.
* I have reviewed the X12 Bylaws (CAP01) and Board Elections (CAP08).
* List your personal and professional reasons for seeking an X12 Board position.
* Briefly describe the personal and professional traits that qualify you for this leadership role.
* Briefly describe your executive leadership experience.
* List previous board experience and industry organizations or associations you belong to, noting any leadership positions.
Candidate Statement
If you are selected for the candidate slate, you will be asked to provide a candidate statement for distribution in advance of the election.

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