2027 Leadership Day Application
Name
First Name
Last Name
Email
example@example.com
Membership Level
Medical Student
Resident
Institution
University of Washington
Washington State University
Trios Health
Virginia Mason
PNWU
St Joseph
Providence Spokane
Year in School / Residency
Anticipated Graduation / End Date
Briefly share your experience with and interestin internal medicine as a career (max. 50 words)
Why do you want to attend ACP Leadership Day and what issue interests you most? (max. 100 words)
Briefly summarize your previous experiences with advocacy (max. 100 words)
Briefly summarize your ACP activities to date –any ACP sponsored events you have attended, abstracts submitted, volunteering for the chapter, etc. (max. 100 words)
In which Washington State congressional districtdo you currently reside?
Submit
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