KAPA Member Volunteer Opportunities Form

KAPA Member Information

KAPA Members interested in serving on a KAPA Committee or learning about other volunteer opportunities are asked to please complete this form.

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* 1. First Name

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* 2. Last Name

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* 3. Designation(s)

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* 4. Organization

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* 5. Email address (By providing your email address you agree to receive emails from KAPA.)

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* 6. Cell phone number

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* 7. Do you authorize KAPA to send text messages to your cell phone?

Yes

No

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* 8. Committee(s) you would like to serve on.

CME Planning Committee

Government Affairs Committee

Membership Committee

Public Education Committee

Student Committee

I am interested in other volunteer opportunities.

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* 9. If other, please indicate your interests.