MMA Policy Council Interest Form

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* Required information.
Your Full Name: *
Your Email Address: *
Phone Number: *
Will you commit to serving your entire term? *
Yes
No
Will you commit to attending and preparing for all Council meetings? *
Yes
No
Are you actively engaged in medical practice? *
Yes
No
Are you comfortable vocalizing your opinion in a diverse setting? *
Yes
No
Have you had experience in policy review, policy development, and/or debate? If so, tell us about it. If not, do you have an interest? *
What constituency could you be a spokesperson for/other professional organizations? *
How would you solicit input from your colleagues as you participate as a TCMS representative on the Council? *
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1300 Godward Street NE, #2000
Minneapolis, MN 55413
612.623.2885  •  Email Us