PSAM Call for Committees 2025

PSAM

Help Shape the Future of PSAM: Apply for a Committee!
Name

First NameLast Name
Credentials
Ex. MD, DO, Pharma, etc.
Work Information

Name of Facility/Organization

Address

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a Current Member of PSAM
If not, we’d love to have you! Membership is required to serve on a PSAM committee. Click Here to Join Today!
Committee(s) of Interest (please check all that apply)
Please rank your interest in serving on "Public Policy" Committee from 1 to 4, with 1 being the most interested.
Please rank your interest in serving on "Education" Committee from 1 to 4, with 1 being the most interested.
Please rank your interest in serving on "PSAM Review" Committee from 1 to 4, with 1 being the most interested.
Please rank your interest in serving on "Advance Practice Providers" Committee from 1 to 4, with 1 being the most interested.
Relevant Experience - describe any previous committee, board, leadership, or advocacy experience.
Personal Statement - state why you interested in serving on this/these committee(s)? What perspectives or skills would you bring?
Additional Comments- Is there anything else you would like PSAM to consider regarding your application?
I understand that committee appointments are voluntary and may involve a time commitment.
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