New York Chapter ACP Member Engagement Form

Are you a New York ACP member looking to get involved in Chapter activities? If so, please complete and submit the following information. We look forward to hearing from you soon!

I would like to volunteer for the following NYACP Committee/Task Force - please check one; Note: Most committees meet between 2-4 times per year via Zoom. New committee and task force member requests are considered annually and appointments are made in April of each year.

I would like to assist the Chapter by volunteering to be an abstract reviewer and/or poster judge. Note: NYACP hosts two poster competitions per year.

I would like to be considered by the Chapter as faculty for a future educational meeting. Please provide area of expertise and talk topic(s).

What are your other interests and areas of expertise? Tell us about yourself including clinical activities and professional interests. This information will help us match you with Chapter involvement opportunities as they arise.

How much time do you have to get involved?

How many years of volunteer experience do you have?

ACP ID# *

Member's First Name *

Member's Last Name *

Member's Credentials *

Member's Email Address *

Member's Phone Number *

Member's Mailing Address *

Fields marked with * are required.

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New York Chapter ACP Member Engagement Form

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