KAPA Member Volunteer Opportunities Form
KAPA Member Information
KAPA Members interested in serving on a KAPA Committee or learning about other volunteer opportunities are asked to please complete this form.
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Designation(s)
(Required.)
*
4.
Organization
(Required.)
*
5.
Email address (By providing your email address you agree to receive emails from KAPA.)
(Required.)
*
6.
Cell phone number
(Required.)
*
7.
Do you authorize KAPA to send text messages to your cell phone?
(Required.)
Yes
No
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8.
Committee(s) you would like to serve on.
(Required.)
CME Planning Committee
Government Affairs Committee
Membership Committee
Public Education Committee
Student Committee
I am interested in other volunteer opportunities.
9.
If other, please indicate your interests.
