VCACC Volunteer Service Application

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

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-speciality*

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

FACCCardiovascular Team Member (NP, RN, PA, Pharm D)FIT
Please select the committee(s) on which you'd like to serve*

Advocacy CommitteeCVTeam CommitteeWomen Cardiologists (WIC) Committee
Committees meet by phone and in person at the MACCS Meeting in November. All committee members are expected to attend the MACCS Meeting. Please indicate if you are willing to be an active participant and attend meetings and conference calls.*

YesNo
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