Application for MSMS Policy Committee

Full Legal Name

Address

Address 1

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Medical Specialty

Type of Practice

Describe any experiences you have serving on boards or committees. What attributes contribute to being an active, constructive member?

Membership organizations must continuously demonstrate value. What experience have you had with membership organizations? How did those organizations demonstrate value to their members?

What experience do you have with healthcare advocacy, public policy or working with governmental or regulatory bodies? How should an organization evaluate the effectiveness of advocacy efforts?

What do you see as your most valuable contribution to the MSMS Policy Committee should you be appointed?

Anything else you would like to share with the Nominating Committee?

Please attach a Curriculum vitae or biography.

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100 MB limit.
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