2027 AAPM&R Resident Retreat Application

2027 AAPM&R Resident Retreat Application

Please complete the following application to be considered for AAPM&R's Resident Retreat taking place on the following weekends: April 17-18, 2027 and May 1-2, 2027. The deadline to complete this application is November 18, 2026.
Applicant Full Name:

First NameLast Name
Degree(s):
Email Address:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
PM&R Residency Program Name:
Please enter your Residency Program Name:
Residency Program City:
Residency Program State:
Are you currently in your second year of PM&R residency? (During the years of 2026-2027)
Are you a current member of AAPM&R?
Academy Membership ID Number:
Gender (Optional):
Do you consider yourself to be a gender or sexual minority (Optional)?
Which of the following may best describe yourself. Check all that apply (Optional):
Do you consider yourself to have a disability as defined by the Americans with Disabilities Act (Optional)?
Which course(s) are you applying to attend? (Note: We may not be able to accommodate changes at a later time) (Check one):
What clinical areas are you currently considering for your future career in PM&R Practice? (Note: It’s okay if you don’t know)!
Why are you interested in attending the AAPM&R Resident Retreat?
Please describe any specific goals you would like to achieve through participation in this program.
Please describe how you have demonstrated leadership or contributed to your residency program or the field of PM&R.
Do you have any interest in volunteering for a professional organization such as AAPM&R?
Any additional comments you’d like to provide on the 2027 Resident Retreat?
Statement 1:
Statement 2:
Statement 3:
Statement 4:
Electronic Signature:
Today's Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Attach CV (png, jpg, jpeg, doc, docs, pdf):

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