By signing up today, your name will be added to the notification lists for the various AcademyHealth volunteer opportunities.

Next time our call for volunteers launches for a particular activity, you will be the first to find out about it.

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* 1. Email

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* 2. First Name

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* 3. Last Name

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* 4. Degree(s)

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* 5. Job Title

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* 6. Please select the option that best describes your career level?

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* 7. Are you able to provide a "Patient Collaborator Perspective?" (AcademyHealth defines patient collaborator as an individual with a lived experience of a health issue/condition requiring direct care from healthcare providers. The patient collaborator designation includes patient surrogates, informational caregivers, advocates, and navigators.)

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* 8. Company/Employer

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* 9. City

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* 10. State

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* 11. How would you describe your racial identity?

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* 12. How would you describe your ethnic identity?

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* 13. How would you describe your gender identity?

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* 14. Please specify the volunteer activities for which you would like to be considered.

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