CAFP Prospective Board Member Interest Form

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This form is intended for members applying only to those positions elected by the CAFP Board or AMAM Delegates (President-elect, Speaker, Vice Speaker, Secretary-Treasurer, AAFP Delegates and Alternates, and At Large Rural or Early Career Physician Directors.) District Directors are elected through a separate process, by plurality of vote from their district members.

The CAFP Prospective Board Member Interest Form will require the following information:

Biographic information (including: uploading a recent CV, a recent headshot, and a brief bio),
Practice information,
Special skills and leadership experience.

Eligibility Confirmation

I have reviewed the required eligibility and qualifications for the position(s) for which I am applying and confirm I am eligible. Read board job descriptions here.

Confirmed

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

Title/Designation

Email Address

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

Mobile Phone #

BIOGRAPHIC INFORMATION

More about you:

Upload Recent CV (.doc or .pdf)

Upload a headshot

Include Brief Bio (approx 250 words)

Local AFP Chapter

Select your local AFP Chapter

Current or Past Leadership

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

Why are you interested in serving on the CAFP Board? If you are applying for a specific board position (i.e. Secretary-Treasurer), what specific skills or experience do you have related to this position?

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

Other

JEDI Perspective

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

Other Information

Do you have any other information you would like to include for consideration?

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CAFP Prospective Board Member Interest Form

BIOGRAPHIC INFORMATION

PRACTICE & EXPERTISE