Professional Development Instructor Interest Form

Yes! Keep me in the loop. I want to be notified about future opportunities to apply to serve as an AMIA Professional Development Instructor and participate in the development of content for AMIA’s Digital Learning Program.

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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. Email
(Don’t worry. Periodic updates only. No spam!)

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* 5. Please identify your primary informatics domain

Clinical informatics (e.g., dental, imaging, medical, nursing, pharmacy)

Clinical research informatics

Health informatics

Public health informatics

Public policy related to informatics

Translational bioinformatics

Other (please specify)

Professional Development Instructor Interest Form

Question Title

* 1. First name

Question Title

* 2. Last Name

Question Title

* 3. Credentials

Question Title

* 4. Email(Don’t worry. Periodic updates only. No spam!)

Question Title

* 5. Please identify your primary informatics domain

* 4. Email
(Don’t worry. Periodic updates only. No spam!)