ASSH Committee Application 2012-2013

New This Year!! In the spring of 2011 President W.P Andrew Lee, MD created the ASSH Member Engagement Task Force and appointed Scott Kozin, MD to Chair this group. The group was tasked with improving the volunteer member experience in an effort to increase engagement. In December, Council accepted the Task Force’s recommendation to revise the ASSH website to offer members more information about our volunteer opportunities. Now in addition to the committee's charges, you will now find information about the time commitment and specific responsibilities for each group. With this information, we hope to encourage you to serve on committees that match with your skill set and interests, as well as your availability throughout the year.

Thank you for your interest in volunteering with us. Efforts by our members are crucial to the success of our volunteer organization. Please complete the following application by April 2, 2012.

View the updated committee listing on the ASSH website and review the charges carefully. Appointment will begin at the 67th ASSH Annual Meeting in Chicago.

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* 1. Please enter your full name and email address.

Last name:

First name:

Preferred Email:

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* 2. Indicate your ASSH membership status

Resident or Fellow Candidate Member

Post- Fellowship Candidate Member

Active Member (includes Senior and Lifetime members)

Affiliate/Allied Health Member

Please indicate which committee(s) you would most like to serve on, ranking your choices first, second and third. Please describe experience and skills in the spaces provided.

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* 3. Committee 1st Choice:

	Committee name
Selection	Selection Committee name menu

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* 4. Are you CURRENTLY serving on this committee (Y/N)?

Yes

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* 5. Please describe any positions and projects you have completed that are relevant to the this Committee Position.

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* 6. How would you contribute to this committee?

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* 7. Committee 2nd Choice:

	Committee name
Selection	Selection Committee name menu

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* 8. Are you CURRENTLY serving on this committee (Y/N)?

Yes

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* 9. Please describe any positions and projects you have completed that are relevant to the this Committee Position.

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* 10. How would you contribute to this committee?

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* 11. Committee 3rd Choice:

	Committee name
Selection	Selection Committee name menu

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* 12. Are you CURRENTLY serving on this committee (Y/N)?

Yes

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* 13. Please describe any positions and projects you have completed that are relevant to the this Committee Position.

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* 14. How would you contribute to this committee?

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* 15. If there are no vacancies on the committee(s) you selected, would you be willing to serve on any committee?

Yes

Thank you for applying for a committee position.

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