2026 Board Nominations

AAFP ID#: *

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip Code: *

Office Phone Number: *

Cell Phone Number: *

Email Address: *

Member Type: *

If you are a resident, what program do you attend?

If you are a student, what medical school do you attend?

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? *

Digital Signature (Type your full name): *

Date / Time *

LAFP Board of Directors Nomination Form