SECTION ON MEDICAL STUDENTS, RESIDENTS, AND FELLOWSHIP TRAINEES
LEADERSHIP INTEREST FORM
Name:
Training Program:
Address:
Telephone (Day):
(Evening):
E-mail:
Fax:
Year of residency training:
Are you in a combined training program? (Please identify):
AAP Membership Category (check one)
**Note - you cannot run for office if you are not an AAP member
Resident Member:
I am interested in being considered for a liaison appointment (5/1/12 to 12/31/13):
Please note: Residents in their last year of training are not eligible.
_____ Pediatric Care Online (PCO) Editorial Advisory Board (EAB)
The position of Resident Liaison to the Pediatric Care Online (PCO) Editorial Advisory Board (EAB) will be to bring
ideas/recommendations to the EAB meetings on how PCO can better accommodate residents in their daily routine. This
position will be asked to participate in 3 yearly PCO EAB conference calls, as well as participate by phone, or in person
(if attending NCE), at the yearly National Conference and Exhibition PCO EAB meeting in October.
If you are interested in any of the positions listed above, please return this form with the following:
1) CV
2) A brief statement of interest
DEADLINE for submission – February 29, 2012
Barb Miller, Young Physicians Program Assistant
American Academy of Pediatrics
141 Northwest Point Blvd, Elk Grove Village, IL 60007
E-mail: bmiller@aap.org Fax: 847/228-7035