IAFP MIG Proposal Form

Member Interest Group Developing Groups Form
Please fill out this form and IAFP will get back to you. All fields are required to submit a valid application.
Name

First Name Last Name
AAFP Number
Preferred E-mail Address
Preferred Phone Number

Area Code Phone Number
I would like to propose a new Member Interest Group
Name of your Interest Group
Please describe the objective of your MIG and how it reflects the IAFP mission of promoting the value of the specialty of family medicine and improving health for all through advocacy, education and action.
IAFP Active member who would serve as the chair*
List the other IAFP members (active, student or resident) who wish to help launch this MIG. At least 10 must be Active physician members*
Should be Empty:

Member Interest Group Developing Groups Form