SMSNA Existing RIG Application Form

Existing Regional Interest Group (RIG)

Application Form
Regional Interest Groups (RIGs) have been established to make connections between individuals with a similar interest in a designated geographical area. To request to join an existing RIG in your geographical area, please complete the below information.
Your Name:*

First NameLast Name
Designation:*
(MD, DO, PhD, etc.)
Email:*
example@example.com
Review list of RIG's HERE
Which existing RIG would you like to join?*

Albany, NYBirmingham, ALBurlington, VTCentral Virginia-Charlottesville/RichmondChicago, ILCleveland, OHCleveland Clinic, OHColumbus, OHDallas, TXDetroit, MIGainesville, FLHouston, TXIndianaIrvine, CALos Angeles, CAMontreal, QCNashville, TNNew EnglandNew Haven, CTNew York, NYNewark, NJNorthern CaliforniaPhiladelphia, PAPhoenix, AZPortland, ORRochester, MNWinnipeg, MB
How do you feel you can contribute to the RIG you wish to join?*
Should be Empty:

Existing Regional Interest Group (RIG)