1.Please type your full name

2.Email address:

3.What is the date of your application?

4.What is the title of your special interest group?

5.Provide the BACKGROUND information. What need does this issue/proposal address (ASPMN/member/patient/other)

6.In reference to question #5; With which ASPMN goal(s) does this align? (please mark those that apply)

Public Awareness

Professional Resource

Education

Professional Recognition

Other (please specify)

7.Describe what resources will be needed to bring your proposal to fruition. What is the financial impact to ASPMN (i.e. cost, income, or neutral)?

8.Who will be the main SIG Coordinator? Please provide project leader’s name/email and other participants/committee affiliation if applicable. 

9.What other resources are needed to bring this project to completion (e.g. ASPMN management company, technology services, legal services, other committees, volunteers)?

10.How will you recruit new members? Please check all that apply.

Social Media

E-News

ASPMN Website