Membership Committee Interest Form
Thank you for your interest in serving on the WCDDA Membership Committee. The committee supports membership growth, recruitment, retention, and the overall value of WCDDA membership. Members will help develop recruitment and retention strategies, conduct outreach, evaluate member benefits, review membership data, and promote the value of membership. Committee members are appointed by the WCDDA President. We are seeking members representing a range of practice types, career stages, and geographic regions.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
County/Area of Practice
*
Practice Type
Solo practice
Small group practice
Large group practice/DSO
Academic
Government/public health
Other
Years in Practice
Student/resident
0–5 years
6–10 years
11–20 years
21+ years
Why are you interested in serving on the WCDDA Membership Committee?
What do you believe WCDDA could do to attract new members?
What ideas do you have for improving member retention and engagement?
What member benefits, programs, or services do you believe are most valuable or could be improved?
Have you previously served on a WCDDA committee or participated in WCDDA membership activities?
Yes
No
If yes, please describe.
Are you willing to participate in virtual committee meetings, typically held quarterly, attend an annual in-person meeting, and participate in WCDDA network events?
Yes
No
I have questions about the time commitment
I understand that submitting this form expresses my interest in serving on the WCDDA Membership Committee and does not guarantee appointment. Committee members are appointed by the WCDDA President.
Submit
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