AMSPDC Pediatrics Workforce Initiative
Volunteer Engagement Form for New Workgroups
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Institution Name:
Highest Degree:
Specialty:
Are you interested in participating in the workforce initiative workgroup?
Yes! I am interested in being a part of a workgroup!
Not at this time.
Please indicate if you have a particular area of interest to be engaged:
Economic Strategy
Redesign Medical Education
Supporting the Physician Scientist
Enhancing Practice Collaboration
Public Awareness Action Team
All of the Above
None
Submit
Should be Empty: