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Apply to be appointed to an SHM Committee or Task Force

Please submit a SEPARATE submission form and include your name and a one- or two-paragraph statement about your qualifications or interest for each Committee you would like to serve on.

Current members need only apply to committees they currently do not serve on. Once completed, you should receive a confirmation email. If you have not received confirmation, please contact

* First Name:
* Last Name:
* Employer:
* Title in your organization:
* Email:
  SHM Membership #:
In appointing members to SHM Committees and Task Forces, SHM attempts to have the diversity that reflects the SHM membership. To help SHM better understand your background can you please answer a few questions below:
Male Female
Ethnicity - What do you consider yourself?
Practice settings – Where do you practice? (may select more than one if applicable)

How have you been involved with SHM in the Past? (Please check all that apply)
Committee Member Faculty for National or Regional Meeting Other
Chapter Member Quality Improvement project Have not been involved with SHM
in the past
* Committee or Task Force you would like to serve on:
* Specify your qualifications and interests in serving SHM in this capacity: (Maximum characters: 2000)

You have characters left.
* = required Field
 You should receive an email confirmation within 48 hours. If you haven't, please reach out to
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