ASSFN Volunteer Application Survey

Question Title

* 7. Are you currently an ASSFN member?

Yes

Question Title

* 8. What is your professional background?

Question Title

* 9. What are your areas of expertise? (select all that apply.)

Addiction Medicine

Basic Science Research

Clinical Guidelines

Ethics

Medical Education

Neurology

Neurosurgery

Hospice and Palliative Care

Internal Medicine

Pain Medicine

Pain Management

Palliative Medicine

Radiology

Other (please specify)

Question Title

* 10. Which areas of committee service are you most interested in?

	1st choice	2nd choice	3rd choice	4th choice	5th choice
Research	Research 1st choice	Research 2nd choice	Research 3rd choice	Research 4th choice	Research 5th choice
Education	Education 1st choice	Education 2nd choice	Education 3rd choice	Education 4th choice	Education 5th choice
Member Engagement	Member Engagement 1st choice	Member Engagement 2nd choice	Member Engagement 3rd choice	Member Engagement 4th choice	Member Engagement 5th choice
Advocacy and Policy	Advocacy and Policy 1st choice	Advocacy and Policy 2nd choice	Advocacy and Policy 3rd choice	Advocacy and Policy 4th choice	Advocacy and Policy 5th choice
Website and Social Media	Website and Social Media 1st choice	Website and Social Media 2nd choice	Website and Social Media 3rd choice	Website and Social Media 4th choice	Website and Social Media 5th choice

Question Title

* 11. Elaborate on your areas of interest, ranked above.

Question Title

* 12. I want to be contacted for short term volunteer opportunities. Check all that apply.

Social Media Ambassador

Abstract Reviewer

Newsletter Author

Question Title

* 13. What ideas or initiatives would you like to share as a committee member?

Question Title

* 14. If any, what related committee experience do you have with ASSFN or other societies?

Question Title

* 15. For committee service, time requirement is on average 2 hours per month. Members are expected to attend most meetings, held via Zoom, and participate in committee activities. Are you able to meet this commitment?

Yes

Not Sure

Question Title

* 16. Please upload your CV (DOC/DOCX or PDF Format) into Google Drive, Dropbox, or OneDrive and provide us with the URL.

Question Title

* 17. I agree to the ASSFN Volunteer Values:
Mutual respect, Confidentiality, Accountability, Professionalism, Innovation, Duty to act in interest of organization.

Yes

ASSFN Volunteer Application

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Credentials

Question Title

* 4. Email Address

Question Title

* 5. Professional Title

Question Title

* 6. Institution/Organization

Question Title

* 7. Are you currently an ASSFN member?

Question Title

* 8. What is your professional background?

Question Title

* 9. What are your areas of expertise? (select all that apply.)

Question Title

* 10. Which areas of committee service are you most interested in?

Question Title

* 11. Elaborate on your areas of interest, ranked above.

Question Title

* 12. I want to be contacted for short term volunteer opportunities. Check all that apply.

Question Title

* 13. What ideas or initiatives would you like to share as a committee member?

Question Title

* 14. If any, what related committee experience do you have with ASSFN or other societies?

Question Title

* 15. For committee service, time requirement is on average 2 hours per month. Members are expected to attend most meetings, held via Zoom, and participate in committee activities. Are you able to meet this commitment?

Question Title

* 16. Please upload your CV (DOC/DOCX or PDF Format) into Google Drive, Dropbox, or OneDrive and provide us with the URL.

Question Title

* 17. I agree to the ASSFN Volunteer Values:
Mutual respect, Confidentiality, Accountability, Professionalism, Innovation, Duty to act in interest of organization.

ASSFN Volunteer Application

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Credentials

Question Title

* 4. Email Address

Question Title

* 5. Professional Title

Question Title

* 6. Institution/Organization

Question Title

* 7. Are you currently an ASSFN member?

Question Title

* 8. What is your professional background?

Question Title

* 9. What are your areas of expertise? (select all that apply.)

Question Title

* 10. Which areas of committee service are you most interested in?

Question Title

* 11. Elaborate on your areas of interest, ranked above.

Question Title

* 12. I want to be contacted for short term volunteer opportunities. Check all that apply.

Question Title

* 13. What ideas or initiatives would you like to share as a committee member?

Question Title

* 14. If any, what related committee experience do you have with ASSFN or other societies?

Question Title

* 15. For committee service, time requirement is on average 2 hours per month. Members are expected to attend most meetings, held via Zoom, and participate in committee activities. Are you able to meet this commitment?

Question Title

* 16. Please upload your CV (DOC/DOCX or PDF Format) into Google Drive, Dropbox, or OneDrive and provide us with the URL.

Question Title

* 17. I agree to the ASSFN Volunteer Values:Mutual respect, Confidentiality, Accountability, Professionalism, Innovation, Duty to act in interest of organization.

* 17. I agree to the ASSFN Volunteer Values:
Mutual respect, Confidentiality, Accountability, Professionalism, Innovation, Duty to act in interest of organization.