AANA Regional Ambassador Application
Name:
*
First Name
Last Name
Credentials:
*
M.D., D.O., etc
Email:
*
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Your City:
*
Your State:
*
Your Country:
*
Primary Joint Specialty:
*
Please Select
Elbow
Foot/Ankle
Hip
Knee
Shoulder
Wrist
Sports
Are you Board Certified?
*
Yes
No
If Board Certified - What Year?
Please Select
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Have you been involved with AANA Committees in the past?
*
Yes
No
If involved with AANA Committees - What Committees?
0/250
Please check which AANA annual meetings you have attended:
*
2024 (Boston)
2023 (New Orleans)
2022 (San Francisco)
2021 Combined Meeting (Nashville)
2019 (Orlando)
2018 (Chicago)
Please upload a copy of your current CV:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload a letter of intent that describes why you would like to participate in the Regional Ambassador program and what qualities make you a good candidate:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload a letter of recommendation from a peer that supports your candidacy for Regional Ambassador:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: