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Medical Student Section: Board, Council, Committee Application

Medical Student Section: Board, Council, Committee Application

Section 1: Demographic Information
Name: 
Mailing Address:
City:
Zip:
Phone:
E-mail Address:
School (Campus):
Classification as of Aug. 1, 2009
AMA Member  Yes                      No
 
  

Section 2: Board, Council, and Committee Information

If you would like a short description on the board/council/committee positions please  click here  ( PDF ).
 
 
Board/Council/Committee History:
 
 I currently serve as a MSS representative/aternate and wish to remain on the same board/council/committee.
 I currently serve as a MSS representative/aternate and wish to serve on a new board/council/committee.
 I have never served on board/council/committee and wish to do so now.
 
 
 
Choice 1:
Choice 2:
Choice 3:
 
 
 

Would you be willing to serve on more than one board, council, committee?        
   Yes            No
 
 
If it is not possible to assign you to one of your three choices, would you be willing to serve on another board/council/committee?
   Yes             No
 
 
 

Reasons you are interested in serving on a TMA board/council/committee:

 
 
 

Pertinent background information not included in Curriculum Vitae:

 

Last Updated On

May 13, 2016

Originally Published On

March 23, 2010

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