FMDA Committee Sign Up Form 2024-2025

Committee Sign Up
I am interested in joining the following FMDA committees, initiatives, and special interest groups for 2024-2025 (1-year term).
Please check as many as you would like – FMDA members only.
Committees:

Education – Annual Conference planningFundraising: Sponsorship and DonationsGrants Submission Task ForceGovernment/Legislative AffairsInnovation Task ForceJournal ClubMembership DevelopmentNewsletter/CommunicationsPhysicians Orders for Life-Sustaining Treatment (POLST)Quality Champion AwardTechnology Readiness
Yes! I want to volunteer as a Florida delegate or alternate to AMDA – The Society for Post-Acute and Long-Term Care’s Virtual Annual Conference in Charlotte, NC, March 13-16, 2025. All delegates and alternates must be voting members of AMDA.

YesNo
Contact Information
Name:*

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Credentials:
Address:*

Street Address

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Phone Number:*

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Email:*
example@example.com
Thank you for supporting our association.
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