Clone of Reference Committee Nomination 2025

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2026 Reference Committee Application
Please fill out this form and click "Submit". For questions, email Cortney Jones at cjones@flmedical.org no later than 5:00 pm EDT on May 15, 2026.
Name*

First NameLast Name
Date

MonthDayYear
Date
Email*
example@example.com
Cell Phone*

Area CodePhone Number
YesNo
What county or specialty are you a delegate for?*
- Reference Committee I — Health, Education, and Public Policy
  
  Considers resolutions concerning:
  - Public health
  - Medical education
  - Methods to help physicians maintain professional competence
  - Educational and scientific programs for CME; other education-related issues
  - Issues concerning specialty medical societies and Professionals Resource Network
  Reference Committee II — Finance and Administration
  
  Considers resolutions concerning the following, specifically within the FMA:
  - Finance-related issues
  - Administration of the association
  - Ethical and judicial affairs
  - Public relations and communications
  - Bylaws
  - Long-range planning
  - Membership
  - The Foundation for Healthy Floridians (philanthropic programs)
  Reference Committee III — Legislation and Miscellaneous
  
  Considers resolutions concerning:
  - State and/or national legislative issues
  - Grassroots issues and/or programs
  - The Florida Medical Association PAC (FMA PAC)
  Reference Committee IV — Medical Economics
  
  Considers resolutions concerning:
  - Social or economic factors that influence the practice of medicine
  - Issues related to Medicare, Medicaid and other government healthcare programs
  - Healthcare financing and third-party relations
  - Workers’ compensation
  - Group practice issues
  - Practice parameters
  - Data collection
  - Managed care
  - Healthcare reform
  - Health information technology
  - Patient safety
  - The uninsured
  Credentials and Rules Committee
  - Reviews and approves late resolutions
  - Certifies delegate attendance and monitors elections
- Reference Committee I - Health, Education, and Public PolicyReference Committee II - Finance and AdministrationReference Committee III - LegislationReference Committee IV - Medical EconomicsCommittee on Rules and Credentials
- Have you served on a reference committee in the last 10 years? Select up to five below, along with the corresponding year. Please specify if you were chair.
- Council on Medical Education, Science, & Public HealthCouncil on Medical Economics and Practice InnovationCouncil on LegislationCouncil on Ethical and Judicial AffairsOther FMA Councils or CommitteesLeadership Academy1000+ ClubFMA PAC MemberFMA PAC Board of DirectorsAMA DelegateAMA Alternate Delegate
- PresidentPresident-ElectVice PresidentTreasurerSecretary
- Describe any leadership positions you have held in other healthcare organizations (health system, hospital, group practice, etc.)
- YesNo
- If yes, please explain your involvement:
- Should be Empty: