AcademyHealth's Interest Groups are seeking members for their respective advisory committees. Nominations will be accepted through July 10, 2020.  

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* 1. Member Information

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* 3. I am interested in the following role on the advisory committee.  (choose one)

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* 4. Please indicate why you are interested in joining an advisory committee.  Your statement should include why you would be a valuable addition to the advisory committee; your specific strengths and areas of expertise; and examples of the types of engagement you would want to initiate within the Interest Group (no more than 500 words).

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* 5. Accepted nominee profiles are listed on the IG advisory committee roster page on the AcademyHealth website. These profiles include a photo and short biography. Please upload a recent high-resolution headshot. (This will only be used if you are accepted to serve on an advisory committee.)

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* 6. Please provide a short (150-word) biography for the AcademyHealth IG advisory committee webpage profile.

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* 7. I understand that by submitting this form I give my permission for AcademyHealth to utilize my provided photo and biography on their website.

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