Firearm Injury Prevention Special Interest Group Registration Form Survey

The Firearm Injury Prevention Special Interest Group (SIG) will provide a forum for pediatricians and other health care professionals focusing on firearm injury and violence prevention to network, share successes and strategies, promote educational programs, identify and participate in relevant advocacy opportunities, and foster connections among members to address problems specific to local or regional care of children, adolescents, and young adults.

To receive future communications and access content related to the Firearm Injury Prevention SIG you will need an AAP ID number.

Don’t have an AAP ID? Please create a free AAP account here.

1.AAP ID #(Required.)

2.Last Name(Required.)

3.First Name(Required.)

4.Email(Required.)

5.State(Required.)

6.Have you participated in firearm injury prevention efforts through your local/state AAP Chapter?(Required.)

Yes

7.If yes, please share how you have participated as a chapter volunteer or in events held by your local/state AAP chapter?

8.Select areas of interest regarding firearm injury.
Select all that apply.(Required.)

9.Select activities of current or prior engagement regarding firearm injury prevention.
Select all that apply.(Required.)

Federal advocacy efforts

State advocacy efforts

Firearm injury prevention research

Providing clinical anticipatory guidance

Supporting access to and distribution of secure storage devices

Building partnerships with multidisciplinary community-based organizations

Engagement of hospital/community-based violence intervention programs

Other (please specify)

10.Briefly share why you want to engage in firearm injury prevention.(Required.)

11.Select the types of information or opportunities you are interested in being offered by the Firearm Injury Prevention SIG.
Select all that apply.(Required.)

Other (please specify)

12.Please share any additional comments, feedback, or questions for SIG co-chairs and staff.

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