CAFP Engagement Interest Form

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CONTACT INFORMATION

The CAFP Engagement Interest Form will ask you your interest in four key areas:

As a Key Contact for Legislative Action
Involvement in a CAFP Committee
Teaching a course at a CAFP live or virtual event
Being a CAFP Media Spokesperson

You will be asked to include biographic information, including: uploading a recent CV, a recent headshot, and a brief bio.

You will then be asked to provide your practice experience and areas of expertise.

Please complete this form and press "Send" when you're done. Your submission will be sent to CAFP staff and forwarded appropriately for processing.

Questions? Email cafp@familydocs.org.

Contact Information

First Name

Last Name

Email Address

AAFP Member ID (Don't know? Find it here.)

Mobile Phone #

If you're employed, please tell us where:

ENGAGEMENT INTEREST

How would you like to become engaged with CAFP? (check all that apply)

I would like to be part of the NEW Key Contact program

I would like to be involved in a CAFP Committee or NCCL

I would like to teach a course or session virtually or at an upcoming event

I would like to be included as a CAFP media spokesperson

BIOGRAPHIC INFORMATION

If you have submitted your biographic information in the past 12 months, check this box to skip this page.

I have submitted this information and wish to skip this page.

More about you:

Upload Recent CV (.doc or .pdf)

Upload a headshot

Include Brief Bio (approx 250 words)

Current or Past Leadership

Please list any leadership position you have or currently hold with AAFP, CAFP or your local AFP chapter:

JEDI Perspective

How does your perspective enhance CAFP's objective to prioritize justice through diversity, equity and inclusion (JEDI)?

TEACHING INTEREST

	Beginner	Intermediate	Advanced
How experienced are you at teaching?

	Often	Sometimes	Rarely	Never
How often have you included innovative methods for better learning?

If you selected Other as one of your top three choices, please enter it here.

MEDIA SPOKESPERSON INTEREST

Have you previously been interviewed or provided quotes or other information to a reporter or media contact?

YesNoI'm not sure

Have you participated in a media training provided by AAFP, CAFP or another organization?

YesNo

If you have participated in a media training, enter the provider of the training and approximate date the training was conducted.

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Contact Information