Name
Company
Position
Local Office Address (required)
Email
Phone Number
Undergraduate (school and degree)
Postgraduate (school and degree)
Are you a current PA-NABIP/GPAHU/NABIP/ member? YesNo
Have you attended a GPAHU/PA-NABIP event previously? YesNo
Number of years of experience in the Health Insurance Industry ?
In a brief personal statement, tell us about yourself and comment on your views about leadership? Why do you want to participate in a leadership development program? Please highlight any current or previous leadership programs you are/have participated in: Where do you see yourself professionally in the next 3-5 years? What do you hope to gain from this experience from a personal and/or professional basis?
Please provide the name and contact information for two professional references. Professional Reference #1 Name Company
Professional Reference #2 Name
Please attach the following: Current resume (acceptable formats Word document or PDF ) Current headshot (max size 5MB acceptable format jpg ) A letter of professional reference (max size 2MB acceptable format Word document or PDF
By clicking this button, I consent to sending my information to pa-nabip.org and applying for 2024 Emerging Leadership Program
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