2025 Committee Interest Form

Committee Interest Form 2025
Thank you for your interest in participating in a MDS Committee. Please fill out of the following form to document your interest and credentials. The deadline to submit this form is June 15th, 2025.
Name*

First NameLast Name
E-mail*
example@example.com
Country*
Gender
Age Range
Have you served on a MDS Committee before?*
If so, please list the Committee, your role, and term of service
Committee of Interest (One preferred, but you may select up to three)*

ArchivesAwardsBylawsClinical Outcomes Assessment Electronic DevelopmentClinical Outcomes Assessment Education and TrainingClinical Outcomes Assessment Scientific EvaluationContinuing Medical Education (CME)Communication OversightEducationCurriculum Development Sub-CommitteeWeb Based Learning Sub-CommiteeEquality of Access to CareEvidenced-Based Medicine (EBM)Industry Education and ServicesMiddle East Working GroupPeer Review Education and Mentoring ProgramPublication OversightRegional Education Committee (AOS, AS, ES, PAS)Scientific IssuesWebsite Editorial Board
Participation in MDS Events or Courses*
Please List Role, Event, Year (i.e.: Faculty, International Congress, 2015 / Attendee, Young Neurologist Course, 2015)
When did you become a MDS Member?
Why you are interested in this Committee, and what do you bring to the Committee of particular advantage to MDS? Please answer this question for each committee that you indicated interest in serving on.
Archives Committee*
Awards Committee*
Bylaws Committee*
Clinical Outcomes Assessment Electronic Development*
Clinical Outcomes Assessment Education and Training*
Clinical Outcomes Assessment Scientific Evaluation*
Continuing Medical Education (CME) Committee*
Communication Oversight Committee (COC)*
Evidenced-Based Medicine (EBM) Committee*
Education Committee*
Curriculum Development Sub-Committee*
Web Based Learning Sub-Committee*
Equality of Access to Care Committee*
Industry Education and Services Committee*
Membership*
Middle East Working Group*
Peer Review Education and Mentoring Program*
Publication Oversight*
Regional Education Committee (AOS, AS, ES, PAS)*
Scientific Issues*
Website Editorial Board*
Young Members Group Steering Committee*
Should be Empty:

Committee Interest Form 2025