Volunteer Model Interest Form

Volunteer Model Interest Form
Thank you for your interest in serving as a volunteer model for AAPM&R educational programs and events. Complete this form to be added to our volunteer model interest list and receive priority notification about upcoming opportunities throughout the year.

Submitting this form does not sign you up for a specific volunteer opportunity or guarantee placement. Instead, it allows us to keep your information on file and contact you when volunteer model opportunities become available that may match your location, availability, and interests.

We appreciate your willingness to support AAPM&R educational activities and help create meaningful learning experiences for participants across the country.
Personal Information
Name

First NameLast NameDegree(s)
Email Address
example@example.com
Phone Number
Please enter a number where a staff member call to confirm the information below. Format: (000) 000-0000.
The following questions are for demographic purposes only and will not impact volunteer assignments.
AAPM&R Membership Status
Level of Training
Medical School Graduation Year
eg: 2027
Residency Graduation Year
eg: 2027
Should be Empty:

Personal Information