Please provide a brief overview of your background and experiences that would contribute to serving in this role. Please highlight your:

• Leadership skills and experience
• Experience working with physicians or health care professionals
• Experience with collaboration
• Experience with advocacy

Please describe your volunteer experiences including roles and activities.

Please provide a statement of interest in serving on the ABEM Board of Directors. In your response, please address why you want this opportunity and what you can bring to ABEM.

(500-word limit)

By providing your typed signature, you attest that the information you have provided is correct and accurate to the best of your ability.

If unable to upload a professional photo within this form, please email a recent professional photo to mmaisonet@abem.org (optional).

Please include a Letter of Recommendation from a professional colleague who can speak to your qualifications and traits for being an ABEM Public Member Director. If unable to upload it within this form, please email the Letter of Recommendation to mmaisonet@abem.org.