Thank you for your participation! AMSA would like to keep our residents and practicing physicians involved in the shaping of medical education and the quality of our nation's health care system. With your experience with current events, health policy and clinical medicine, we feel that our Alumni members can provide an invaluable service to our medical students. As a member of AMSA's Speakers Bureau, you can share your real-world experiences with medical students, as a speaker, at events such as chapter meetings, regional workshops and national convention. All information you provide is optional and only the items noted (*) will be available in our online directory. All other information will be for our records only.

PART I - GENERAL INFORMATION

Name: *
AMSA 6-digit ID (if applicable):
What leadership role(s) or AMSA activities did you participate in as a student member of AMSA? *
Medical School: *
Graduation Year: *
Residency Program: *
Completion Date: *
Current Specialty/Field of Practice: *
Professional Activities: * (patient care, teaching, administrative, etc.)
Home Address:
Home Phone:
Email: *

PART II - JOIN OUR SPEAKERS BUREAU

I can speak on the following topic(s): *
Include applicable titles of talks and/or BRIEF descriptions in the text box next to the appropriate topic.

Advocacy
Bioethics
Child and Adolescent Health
Community and Public Health
Death and Dying
Direct Action
Disabilities
Disparities in Medicine
Diversity in Medicine
Geriatrics
Global Health
Health Policy
Humanistic Medicine
Leadership Development
Lesbian, Gay, Bisexual and Transgender People in Medicine
Medical Education
Medical Student Well-Being
Military Medicine
Minority Affairs
Neurology
Osteopathy
The PharmFree Initiative
Primary Care
Psychiatry
Resident Work Hours
Revitalizing Professionalism
Surgery
Universal Health Care
Women in Medicine
Other

Are you willing to travel to speak to students? * Yes    No

* AMSA has a email-based listserve for most of these topic areas. If you would like to subscribe to any of these lists, please visit our listserve page. All subscriber emails are used solely for the purpose of the list and are not released to any outside parties. In addition, you may unsubscribe yourself at any time from any lists.