Board Member Application
About the role
Term is three-years with no limits on the number of terms. Board members are expected to attend a one-hour zoom meeting every other month and also attend the entire FMM conference, including any board meetings held before or immediately following the conference. The 2026 conference is in Indianapolis September 11-12, and 2027 will be back in the Chicagoland area . Board members may be asked to serve on task forces, join one of the three FMM Learning Networks, and work on specific assignments for the FMM Board to further the mission and promote the conference. All applications are reviewed by the current FMM Board and Staff.
Criteria to serve on the board
Board members must live and work in any of the 12 states. Applicants should have attended at least one prior FMM conference.
Desired Qualifications and Experiences
The board will strive to have geographic diversity to represent the states in the region and individual diversity to include variety of experiences. Current affiliation or strong connection with an allopathic or osteopathic medical school in the FMM twelve-state region. Prior and current participation in a Family Medicine Midwest learning network is a plus.
Name
First Name
*
Last Name
*
Do you currently take care of patients?
*
Yes
No
I am a
Practicing Physician
Administrator
Educator
Retired from practice
Current Organization/Practice/Employer
*
What Medical School(s) are you affiliated with?
*
What year(s) did you attend Family Medicine Midwest?
Check if you have served on these FMM committees
Conference Planning Committee
Education Program Committee
Which Learning Network(s) are you currently involved with ?
Faculty Development
Perinatal Health
Scholarly Activities
None
You can add any specifics about your Learning Network Activity here
Have you presented at FMM? Check all that apply
*
Presented a Poster
Presented a session
Will submit an abstract in 2026
None of the above
Please detail specific experience, connection or resources that you can bring to support the mission, outreach and success of Family Medicine Miwest
Mailing Address
Street Address
Address Line 2
City
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Postal Code / Zip Code
E-Mail
*
Cell Phone Number
*
Are you a member of the AAFP?
*
Yes
No
Provide the name and email address of a family medicine reference for you
*
Please upload your CV here
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