I am interested in Volunteering for the SoWH Pregnancy and Postpartum Special Interest Group (PPSIG)!
Full Name
*
First Name
Last Name
Designation/Credentials (i.e. PTA, SPT, PT, DPT, WCS)
*
SOWH/APTA Member ID#:
*
E-mail
*
If you are under 18, please provide your parent's e-mail address.
Cell Phone
*
-
Area Code
Phone Number
Alternate Phone
-
Area Code
Phone Number
What is your APTA Member Type?
*
PT
PTA
DPT-Student
PTA-Student
Which volunteer role(s) interest you?
*
Executive Committee - Chair
Executive Committee - Vice-Chair
Executive Committee - Vice-President
Executive Committee - Secretary
PPSIG Volunteer Leaders (not Exec Committee)
PPSIG Committee Member
What are your member classifications?
*
Early Professional (w/in 5 years of graduation)
Member at Large
Former SoWH Committee Chair (any SoWH Committee)
Former SoWH Board Member
Former APTA Committee Chair (any APTA Committee)
Former APTA Board Member/House of Delegates
Not Applicable
THANK YOU!
If you have any questions, please contact the SoWH at info@womenshealthapta.org.
Submit Application
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