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* 1. First Name

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* 2. Last Name

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* 3. Credentials

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* 4. Employer

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* 5. Email Address

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* 6. Phone Number

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* 7. Medical Specialty

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* 8. Previous Experience: Please share any previous committee or leadership experience you have with PA Organizations, Community Organizations or National Organizations.

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* 9. On which committee would you like to serve?

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* 10. To join a committee, you need to be a current TAPA Member. Please verify that you are a member. If you are not a member, join today!

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