Az Psych 2026-2027 Executive Officer and Committee Interest Submission Form

Az Psych 2026-2027 Executive Officer and Committee Interest Submission Form
Thank you for your interest in contributing to the leadership of the Arizona Psychiatric Society. Please complete the information below and submit the same. Committee interest will be considered immediately; executive officer interest will be considered by the Nomination Committee in early 2026 for the slate for 2026/2027.
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Organization or Residency/Fellowship Program*
Psychiatric Practice Type*

General AdultChild & AdolescentGeriatricAddictionForensicConsultationResearchAdministration/Managed CareTraining/TeachingOther
Please select which Committee or Work Group you would like to be added to (provided your membership is current, we will add you to these groups upon receipt of this form) (if only submitting this form for interest in executive office, please select None for this question). For more information on any of these positions, please contact psychiatry@azmed.org. *
Please select which executive officer position you are applying for (or if only submitting to express an interest in a Committee, please select None for this question). For more information on any of these positions, please contact aschnock@azmed.org:*
Should be Empty: