MAOFP CONSENT TO SERVE 2020

MEMBER INFORMATION

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* Contact Information

Name: *

Credentials:

City/Town: *

Email: *

Phone: *

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* Employment

Employer:

Present Position:

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* I consent to be considered for the following position:

Director

Resident Alternate Board Member

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* Briefly describe your involvement with MAOFP.

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* You are encouraged to submit a brief personal statement addressing why you would like to serve on the MAOFP Board of Directors and what you hope to accomplish as a board member.

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* I have read the MAOFP Bylaws and duties for this office and if elected, I will serve MAOFP the interest of osteopathic medicine and abide by the MAOFP Bylaws and Policies and ACOFP's Code of Ethics.

If elected, it is my obligation to attend meetings and do the work of the position. If I am unable to fulfill this commitment, I will resign.

Each candidate is required to send their CV to director@maofp.org.

If elected, I will receive links to the following forms that must be completed prior to the first meeting.
1. Volunteer Participation Agreement
2. Conflict of Interest Policy

Completion of the line below serves as the electronic signature of the individual completing this form.

Name:

Date: