AMSA Speakers Bureau Volunteer Form

Thank you for your participation! AMSA would like to keep our residents and practicing physicians involved in the shaping of medical education and the quality of our nation's health care system. With your experience with current events, health policy and clinical medicine, we feel that our Alumni members can provide an invaluable service to our medical students. As a member of AMSA's Speakers Bureau, you can share your real-world experiences with medical students, as a speaker, at events such as chapter meetings, regional workshops and national convention. All information you provide is optional and only the items noted (*) will be available in our online directory. All other information will be for our records only.

PART I - GENERAL INFORMATION

Name: *
AMSA 6-digit ID (if applicable):
What leadership role(s) or AMSA activities did you participate in as a student member of AMSA? *
Medical School: *
Graduation Year: *
Residency Program: *
Completion Date: *
Current Specialty/Field of Practice: *
Professional Activities: *
(patient care, teaching, administrative, etc.)
Home Address:
Home Phone:
Email: *

PART II - JOIN OUR SPEAKERS BUREAU

I can speak on the following topic(s): *
Include applicable titles of talks and/or BRIEF descriptions in the text box next to the appropriate topic.

Business of Medicine
Child and Adolescent Health
Community and Environmental Health
Culture of Medicine
Death and Dying
Direct Action
Disabilities
Disparities in Medicine
Diversity in Medicine
Gender & Sexuality
Geriatrics
Global Health
Grassroots Leadership
Health Policy
Humanistic Medicine
Medical Education
Medical Student Well-Being
Military Medicine
Race, Ethnicity and Culture in Health
Neurology
Osteopathy
PharmFree
Primary Care
Psychiatry
Resident Work Hours
Revitalizing Professionalism
Surgery
Health Care for All
Other

Are you willing to travel to speak to students? * Yes    No

* AMSA has a email-based listserve for most of these topic areas. If you would like to subscribe to any of these lists, please visit our listserve page. All subscriber emails are used solely for the purpose of the list and are not released to any outside parties. In addition, you may unsubscribe yourself at any time from any lists.

 

In addition to giving of your time and talent, please consider a gift to the AMSA Foundation to support leadership development opportunities for the next generation of physicians.