Interest Group Medical & Premedical Facilitator Application
Please complete and submit the form below to declare your candidacy for an Interest Group Facilitator position.

Questions? Email Liz Wiley at vpia@amsa.org.
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I am applying for the position of... *
(Check only one box)
Name: *
Email address: *
School: *
Anticipated Graduation Year: *
Phone number: *
Street Address: *
City: *
State: *
(Country if international)
Zip Code: *
In 250 words or less, please describe your goals as an Interest Group leader for 2012-2013. *
Application & Resume/CV Submission. *
Please email your resume/CV to Liz Wiley at vpia@amsa.org and Mark Bedner at mbedner@amsa.org.
Required
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This form was created inside of American Medical Student Association.