2025 OMA Committee Interest Form

Volunteer Responsibilities

OMA committee members are appointed by the leadership and report to the chair of the committee they are assigned to. Committee members actively participate in the work of the committee, provide thoughtful input on deliberations, focus on the best interests of the OMA, and work toward the accomplishing the committee’s goals. Members are requested to make a good-faith effort to attend committee meetings, review advance materials, and review and reply to emails/phone calls. During committee deliberations, members shall disclose any conflicts of interest that may arise and refrain from voting in accordance with the OMA Committee Conflict of Interest Policy. Each committee member brings their own unique talents, viewpoints and contributions. A difference of opinion contributes to a healthy discussion of critical issues impacting the practice of medicine, and interactions should always be civil. The interest form below includes demographic questions that will help the OMA construct committees that represent the diversity of the organization and the state.

Question Title

* 1. Submitted by:

Name

Email Address

Phone Number

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* 2. Professional Designation

Physician

Physician Associate

Resident

Student

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* 3. My specialty is (if applicable):

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* 4. My clinic or employer is (if applicable):

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* 5. My practice location is:

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* 6. Type of employment or practice:

Employed by a health system

Employed by a clinical practice

Owner or part-owner of a practice

Public health/government

Academic

Other (please specify)

Question Title

* 7. My career level is

Resident/Fellow

Early Career (non-resident, first 10 years of practice)

Mid-career (11 - 30 years of practice)

Late-career (31+ years of practice)

Retired

Not currently employed

Question Title

* 8. I am interested in serving on the following committee(s):

Finance & Audit Committee

Governance Committee

Justice, Equity, Diversity and Inclusion Committee

Legislative Committee

Policy Committee

2025 OMA Committee Interest Form

Volunteer Responsibilities

Question Title

* 1. Submitted by:

Question Title

* 2. Professional Designation

Question Title

* 3. My specialty is (if applicable):

Question Title

* 4. My clinic or employer is (if applicable):

Question Title

* 5. My practice location is:

Question Title

* 6. Type of employment or practice:

Question Title

* 7. My career level is

Question Title

* 8. I am interested in serving on the following committee(s):

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* 9. Please explain why you are interested in serving on this committee in 250 words or less (or committees if selecting more than one option).

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* 10. I agree to comply with the OMA's committee conflict of interest policy.

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* 11. Additional comments (optional):