2021 Volunteer for Committee Form

Committee Selection
Please click the link below to review the committee descriptions: 
https://www.vascularmed.org/i4a/pages/index.cfm?pageid=3572
 

Name *
Degrees; (e.g. MD, BS, BA, MPH PhD, etc.) *
Work Email *
Personal Email
Work Phone *
Cell Phone
Committee Choice #1 *

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Relevant Skills/Qualifications/Experience: if you have relevant experience, please describe herein for this 1st Choice committee
(Maximum characters: 2000)
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Committee Choice #2

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Relevant Skills/Qualifications/Experience: if you have relevant experience, please describe herein for this 2nd Choice committee
(Maximum characters: 2000)
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Committee Choice #3

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Relevant Skills/Qualifications/Experience: if you have relevant experience, please describe herein for this 3rd Choice committee
(Maximum characters: 2000)
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Years in practice *

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Enter any skills/qualifications that can be used outside of committees/task forces
(Maximum characters: 2000)
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Any Additional Comments
Upload Your CV *
I understand that participation in any committee requires membership in good standing *

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