Thank you for your interest in volunteering for the Academic Pediatric Association. Please fill in the requested information and select the opportunities that interest you. If you have any questions, please email Laura Turner at laurat@academicpeds.org.

Please visit this webpage for position descriptions, time commitments, etc.

Please complete this form by September 14, 2018.

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* 1. Name:

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* 2. Title:

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* 3. Institution: 

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* 4. City:

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* 5. State:

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* 6. Phone:

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* 7. Email address:

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* 8. Please check all the volunteer leadership opportunities you are interested in:

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* 9. Have you previously served on an APA Executive Committee and/or Task Force? If so, which one?

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* 10. Please list any other APA leadership roles you have assumed and describe your role (i.e. SIG and/or Region Chair):

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* 11. Please attach your CV here:

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* 12. Please include a brief statement of interest for the positions of interest to you. 

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