AVA Volunteer Application

AVA Volunteer Application
AVA's successes over time are due to the commitment and efforts of many volunteer members. There are many volunteer roles that use members' knowledge, skills and experience in a variety of ways in exchange for opportunities to contribute to advancing the science and practice of vascular access, networking with colleagues, and personal and professional development. As volunteer roles open, (as terms expire or new roles are created) applications on file will be reviewed, with open volunteer positions filled from the pool of applicants. You must be and remain an active AVA member while you serve on an AVA Task force, committee or SIG leadership unless prior approval is given by AVA.

* Please note that you will be asked to upload your curriculum vitae or resume and current headshot (photo) at the end of this form.

If you are interested in applying to be on the AVA or AVA Foundation Board, please click this link https://www.avainfo.org/page/CallforAVALeaders and fill out the form for those opportunities.
1. Contact information
Name:*
Credentials:*
YesNoNot eligible
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Cell Number*

Area CodePhone Number
Home Number

Area CodePhone Number
Please list any languages you speak fluently other than english
2. Employer information
Employer Name*
Your Title*
Work Phone:

Area CodePhone Number
3. Preferred Contact Info
HomeWorkCell
4. Current experience
Years as AVA member*
Years in the field of Vascular Access*
AcademicsAnesthesiaInterventional OncologyInterventional RadiologyPediatricsPharmacyCardiologyClinical EducationClinical ResearchCritical CareEducation & TrainingHomecare/Home InfusionInfectious DiseaseManagementMarketingMedical-Surgical In-PatientNeonatal CareNephrologyOncologyOutpatientPatient Safety/AdvocacyPhysician OfficePulmonologyRadiologyRespiratory CareSalesOther
If Other (please specify)
Acute Care (In-Patient)AdultAmbulatory CareBasic Professional Education FacultyCritical CareDirect Care (Insertion & Maintenance)HospitalistIndustry Clinical SupportIndustry R&DIndustry SalesInfectious DiseaseIn-Service EducationInterventional RadiologyNeonatalNephrologyOncologyOperating Room/SurgeryPatient Safety/AdvocacyPediatricPharmacyV.A. Team ManagerOther
If Other (please specify)
Acute Care HospitalAmbulatory Care (Hospital-based)Ambulatory Care (Non Hospital-based)Community College (2-yr)ConsultantGroup or Private PracticeHome Infusion/HomecareIndependent ContractorLong-term Subacute Hospital (L-TACH)Medical Device IndustryOther Long-Term Care FacilityPharmaceutical IndustryPublic HealthUniversity/CollegeOther
If Other (please Specify)
LPNRNClinical Nurse SpecialistNurse PractitionerCare, Use & Maintenance of Vascular Access DevicesClinical ManagerEducation (Academics)Education & Training (Clinical)Marketing / Sales ProfessionalPhysicianPhysician AssistantPlacement of Vascular Access DevicesR&D ProfessionalRadiology TechnologistRespiratory TherapistVascular Access Team MemberOther
If your title or role is not listed above please list here
5. Volunteer Opportunities

Please check below all volunteer opportunities you are interested in joining.
Board Development Commission (2-year commitment)Bylaws and Policy Committee (2-year commitment to review AVA's governance documents)Clinical Education Task Forces (up to 1 year commitment to write and develop clinical assets)Clinical Review Committee (Team) (variable- days to weeks to review and evaluate clinical assets)D-Team (1 to 2-year commitment to plan annual meeting)PediNeoSIG (1 to 2-year commitment to serve as a leader on the Pediatric Special Interest Group)Other Task Forces as they come available
Clinical Review Experience*
Clinical Review: Please list previous experience as a formal reviewer for documents, articles, standards, guidelines, etc. *
What assets and experience do you bring to the volunteer role(s) that you selected above.*
Please list any relevant previous experience as a volunteer:*
What do you hope to accomplish as a volunteer for AVA?*
Attribute #1:*
Attribute #2:*
Attribute #3:*
Upload CV or resume*

Upload a File

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Upload current headshot*

Browse Files

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AVA volunteer groups (committees, task forces, SIGs) may coordinate a face to face meeting while at the AVA Annual Scientific Meeting. Please indicate below if you will be in attendance.
YesNoI am not sure yet
Should be Empty:

AVA Volunteer Application

1. Contact information

2. Employer information

3. Preferred Contact Info

4. Current experience

5. Volunteer Opportunities