MN-ACP Council and Committee Chair Nominations-2024

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* 1. Please provide your name and contact information.

Name:

Degrees:

Preferred email:

Preferred phone number:

City of residence:

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* 2. What is your current position?

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* 3. How would you describe your current position(s)? Select all that apply.

General internist

Academic

Hospitalist

Subspecialist

Retired

Part-time physician

Other

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* 4. Which position on the Council are you interested in?

Membership Committee chair

Early Career Physician chair

Hospitalist Committee chair

"at-Large" Council member representative

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* 5. Why do you want to serve on the MN-ACP Council and what qualities would you bring to the Council if elected? (200 words max)

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* 6. What would be your areas of interest in working on the Council? (200 words max)

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* 7. Please submit an electronic copy of your CV to Minnesota.ACP@gmail.com for the Nominations Committee consideration by May 15, 2024. A slate of candidates will be selected by July 1, 2020 and all candidates will be notified. If you have additional questions, please email Minnesota.ACP@gmail.com

Do you have any additional information you would like added to this nomination (200 word max)?