PaACC Volunteer Service Application

PaACC Volunteer Service Application
The President of the Pennsylvania Chapter, American College of Cardiology appoints members to serve on sections and task forces for a term two-year term that may be renewed once for a total of four years of service. The Pennsylvania Chapter is interested in appointing Fellows, Assistant Fellows, FITs, and Cardiovascular Team Members to Sections.

Please complete the information below.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Degrees*
e.g., MD, MBBS, PharmD, PA-C, ARNP, etc.
Type of Practice*
Name of Institution or Facility*
Sub-specialty*

Adult Congenital & PediatricCardio-OncologyCVTeamElectrophysiologyGeriatricHeart Failure & TransplantImagingInterventional
Number of years ACC Member*
City*
Type of Membership*

Associate FellowCardiovascular Team (e.g., RN, PA, PharmD)FACCFIT
Please select section(s) on which you'd like to serve*

AdvocacyCardio-oncologyCardiovascular TeamEducationFITWomen Cardiologists (WIC)
Sections meet by phone and in person at the PaACC Fall Meeting. All section members are expected to attend the PaACC Fall Meeting. Please indicate if you are willing to be an active participant and attend meetings and conference calls.*

YesNo
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