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1. Consumer representative residing in the following counties: a. Orange—4 representatives needed. b. Madison—1 representative needed. c. Culpeper—1 representative needed. d. Fauquier—3 representatives needed. e. Rappahannock—1 representative needed. 2. Provider representatives in the following categories: a. Group 1—2 physicians, l mental health professional, and 1 pharmacist. b. Group II—Health Care. Insurer.
if you would like to be considered and would like further explanation, complete the following and return to: Northewestern Virginia Health Systems Agency, Inc. c-o Richard C. Camp 2015 Ivy Road, Suite 314 Charlottesville, VA 22903
NAME
TEL. NO.
AGE SEX RACE
MAILING ADDRESS
ZIP CODE
OCCUPATION
OCCUPATION OF SPOUSE
CITY OR COUNTY OF RES.
POSITION FOR WHICH YOU WISH TO BE CONSIDERED:
PROVIDER
CONSUMER
All applicants will be contacted and given further information on the specific qualifications (if any) for the positions and to answer any questions about the Agency.
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