FCACC Volunteer Service Application

The President of the Florida Chapter, American College of Cardiology appoints Florida ACC members to serve on committees and task forces for a term two-year term that may be renewed once for a total of four years of service. The Florida Chapter is interested in appointing Fellows, Assistant Fellows, Members, FITs, and Cardiovascular Team Members to committees.

Please complete the information below.

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Degrees

e.g., MD, MBBS, PharmD, PA-C, ARNP, etc.

Type of Practice

Name of Institution or Facility

City

Subspecialty

Number of years ACC Member

Type of Membership

If you chose FIT above, please give the Month and Year of your planned graduation.

Please select which committee(s) on which you'd like to serve

Please rank the committees on which you'd like to serve. Typically you will receive at least one of your top 3 choices.

Please select up to three committees on which you'd like to serve. Indicate your interest by ranking them 1st, 2nd and 3rd.

Rows	1st Choice	2nd Choice	3rd Choice
Advocacy Committee
Cardiovascular Team Committee (Nurse, PA, PharmD, etc.)
Cardio-oncology Committee
Early Career Committee
Education
FIT Committee
FMA Delegation Committee
International Committee
Payer Relations & Health Care Economics Committee
Quality of Care Committee
Women Cardiologists (WIC) Committee

Committees meet by phone and in person at the FCACC Annual Meeting. All committee members are expected to attend the FCACC Annual Meeting. Please indicate if you are willing to be an active participant and attend meetings and conference calls.