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Myositis Medical Expert Volunteer Interest Form
Contact Information
1.
Name
2.
Professional Credentials (e.g., MD, DO, PhD, PT, OTR/L, NP)
3.
Current Position/Title
4.
Institution/Organization
5.
Email Address
6.
Phone Number
7.
Address, City, State, Zip Code (or equivalent)
Professional Background
8.
Primary Area(s) of Expertise (check all that apply)
Rheumatology
Neurology
Dermatology
Pulmonology
Physical Medicine & Rehabilitation
Physical Therapy/Occupational Therapy
Immunology
Speech and Language Pathology
Pathology
Pediatrics
Nursing
Clinical Research
Basic Research
Translational Research
Other (please specify)
9.
Years of Experience in Myositis Care and/or Research
Less than 5 years
5-10 years
11-20 years
More than 20 years
10.
Please indicate your area(s) of myositis expertise (check all that apply)
Antisynthetase Syndrome
Dermatomyositis
Immune-Mediated Necrotizing Myopathy
Inclusion Body Myositis
Juvenile Myositis
Polymyositis
Interstitial Lung Disease
Autoantibodies/Biomarkers
Clinical Trials
Basic Science Research
Other (please specify)
11.
Are you currently involved in myositis research?
Yes
No
Volunteer Interests
12.
Which volunteer opportunities interest you? (check all that apply)
Medical Advisory Board service
Research grant review
Webinar presentations
Conference presentations (e.g., MyoCon)
Educational content review
Website content review
Publications review
Participation in expert panels
Research advisory activities
Advocacy initiatives
Media interviews or expert commentary
Other (please specify)
13.
Have you previously volunteered with The Myositis Association?
Yes
No
If yes, please describe your involvement.
Medical Advisory Board Interest
14.
Are you interested in being considered for service on TMA's Medical Advisory Board?
Yes
No
I would like to learn more
15.
If selected, would you be willing to serve a three-year term?
Yes
No
Unsure
Statement of Interest
16.
Please provide a brief statement (200 words) describing:
* Your interest in supporting The Myositis Association
* Relevant experience in myositis care, research, or education
* How you hope to contribute to TMA's mission through volunteer service
17.
Please upload your current CV or résumé.
Accepted formats: PDF, DOC, DOCX
File size limit is 16MB
Choose File
No file chosen
18.
Is there any additional information you would like us to consider regarding your expertise, experience, or areas of interest?
Consent
19.
I understand that submission of this form does not guarantee appointment to the Medical Advisory Board.
Yes
20.
I agree that The Myositis Association may retain my information and contact me regarding Medical Advisory Board openings and other volunteer opportunities that align with my expertise.
Yes
Thank you for your interest in serving The Myositis Association. We are grateful for your willingness to share your expertise with the myositis community.
