2016 Commission Request (Members currently on a commission)

Please complete this survey if you are a current commission member. This will assist the incoming NYSAFP President with commission assignments. Thank you.

Question Title

1. Contact Info (Required.)

Name

Email Address

Best Phone Number

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2. Current Commission

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3. Are you interested in being commission chair or vice chair?

Yes

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4. If Yes, please check which:

Chair

Vice-Chair

Either

2016 Commission Request (Members currently on a commission)

Question Title

1. Contact Info (Required.)

Question Title

2. Current Commission

Question Title

3. Are you interested in being commission chair or vice chair?

Question Title

4. If Yes, please check which:

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5. If you would like to serve on a different commission, please indicate your choice below:

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6. Are you a student, resident or residency graduate? (Choose one)

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* 1. Contact Info (Required.)

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* 2. Current Commission

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* 3. Are you interested in being commission chair or vice chair?

Question Title

* 4. If Yes, please check which:

Question Title

* 5. If you would like to serve on a different commission, please indicate your choice below:

Question Title

* 6. Are you a student, resident or residency graduate? (Choose one)

1. Contact Info (Required.)

2. Current Commission

3. Are you interested in being commission chair or vice chair?

4. If Yes, please check which:

5. If you would like to serve on a different commission, please indicate your choice below:

6. Are you a student, resident or residency graduate? (Choose one)