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LAFP Board of Directors Nomination Form
If you are interested in serving on the LAFP Board of Directors or have recommendations for consideration of the Nominating Committee, please submit this nomination form by
March 21, 2025
.
I am interested in the following position:
*
President-Elect
Vice President
Secretary
AAFP Delegate
AAFP Alt. Delegate
Speaker
Vice Speaker
District 1 Director
District 1 Alt. Director
District 4 Director
District 4 Alt. Director
District 5 Director
District 5 Alt. Director
District 6B Director
District 6B Alt. Director
District 7 Director
District 7 Alt. Director
District 8 Director
District 8 Alt. Director
Resident Representative
Resident Alt. Representative
Student Representative
Student Alt. Representative
AAFP ID#:
*
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Office Phone Number:
*
Cell Phone Number:
*
Email Address:
*
Member Type:
*
Active
Resident
Student
If you are a resident, what program do you attend?
If you are a resident, what year of residency are you in?
PGY1
PGY2
PGY3
If you are a student, what medical school do you attend?
If you are a student, what year of medical school are you in?
MS1
MS2
MS3
MS4
1. Please tell us why you would like to serve on the LAFP Board of Directors.
*
2. What special skills, experiences and contributions will you bring to the LAFP as a potential Board Member?
*
3. What do you hope to contribute/gain from the experience?
*
I understand and agree to the requirements of a Board position:
*
Yes
No
Digital Signature (Type your full name):
*
Date / Time
*
Submit
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