AMA-RFS Sectional Delegate Nomination Form

AMA-RFS Sectional Delegate and Alternate Delegate Nomination Form
Welcome to the electronic application for AMA-RFS Sectional Delegate and Alternate Delegate positions.

This form replaces the traditional paper application. Note that except where otherwise stated, information that you provide via this application will be made available online to members of your Section and other AMA Members exactly as you submitted it - AMA Staff cannot alter your application to correct spelling or other errors.

Before you begin, consider preparing / locating the following application pieces:
1. A professional, high resolution headshot (optional)
2. Signed Letter of Endorsement from State or Specialty Society (Download from here before obtaining signature)
  - All RFS Sectional Delegates and Alternate Delegates must have an endorsement from a state or specialty society in the House of Delegates before the election.
If you need to save your application and return to it at a later time, click the "Save" button at the bottom of the page. You will then receive an email with a link to return to your application via the email address you provided.

If you have any questions, please email RFS@ama-assn.org.

Applicant information

Of the information collected in this section of the application, only your name, credentials, and pronouns (if any selected) will be made available online for review by members of your Section and other AMA Members.
Name*

First NameMiddle NameLast Name
Credentials*
DO, MD, MPH, etc.
What are your pronouns? Select all that apply.

He/HimShe/HerThey/ThemRather not sayOther
Current City and State of residence*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Primary phone number*

Area CodePhone Number

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Please select the position for which you are applying.

AMA-RFS Sectional Alternate Delegate
All unsuccessful Sectional Delegate candidates will have the option to be considered in the election for Sectional Alternate Delegate alongside those candidates who ran specifically for Sectional Alternate Delegate.

AMA-RFS Sectional Delegate and Alternate Delegate Application
Position Description

Sectional delegates are voting members elected by the RFS Assembly to represent the interests of resident and fellow physicians in the House of Delegates. The Delegates and Alternate Delegates are credentialed representatives who must be AMA members. They represent various constituencies, such as state and specialty medical societies. Each Delegate and Alternate Delegate must receive written endorsement from a society or organization currently seated in the House of Delegates. All elected Delegates and Alternate Delegates will serve a one-year term, unless elected during an off-cycle election. If elected during an off-cycle election, they will serve during the following Interim meeting.
Responsibilities and time committment

The primary responsibilities of Sectional Delegates/Alternates are as follows:
- Fully attend the Annual and Interim meetings.
- Assist in the policy review process, which takes place in the month leading up to the meetings, by reviewing resolutions and attending virtual team meetings.
- Attend all RFS caucus meetings, both virtual and in-person, to assist our caucus in developing stances on resolutions.
- Attend and participate in state and specialty society review processes as a way to strategize and advocate on behalf of RFS priorities.
The time commitment is approximately:
- One hour per month in our “non-busy” times (January, February, March, July, and August).
- Two to three hours per month In our “ramping up” months (April and September).
- Two to three hours per week in our “busy” months (May, June, October, and November).
- During the meetings, it is expected that you participate in all meetings, which generally span from 7a-7p.
Program Year*
Program name*
Program location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected program completion date*

MonthDayYear
Date
What is your medical specialty?*
Please read section V.D. of the AMA-RFS Internal Operating Procedures for an overview of our campaign rules.
I have read and agree to abide by all campaign rules as outlined in the RFS Internal Operating Procedures.*

Yes

Program Director information
Following the election, the AMA will send your program director a letter letting
them know you were elected to a position. In that letter, we will also explain your national role and attendance expectations concerning meetings.
Program Director Name and Credentials*

First NameLast NameCredentials
Program Director email address*
example@example.com
What institution are you affiliated with for training? *

Endorsement
All RFS Sectional Delegates and Alternate Delegates must have an endorsement from a state or specialty society in the House of Delegates before the start of the election. A complete list of organizations represented in the AMA can be found here. If you need help securing an endorsement, please contact the current RFS Governing Council at RFS@ama-assn.org.
Do you currently have an endorsement from a State or Specialty Society?*

YesNo
Please provide your endorsing organization *
State or Specialty Society name
Upload State or Specialty Society endorsement*

Browse Files

Cancelof

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Are you an AMA member?*

YesNo
Your answer to the following question will be included on your election placard. Feel free to answer in bullet form, or in sentence fragments.
What relevant leadership experience or advocacy experience have you had within the AMA, other areas of organized medicine, or outside of organized medicine? (100 words max)*

Limited leadership experience is ok- this is an entry level role.0/100
Professional headshot (optional)

Browse Files
.JPEG or .PNG only Cancelof

Acknowledgements
All appointed delegates and alternate delegates are required to adhere to the expectations below. Failure to meet these expectations may result in removal from the elected position. After reviewing, please acknowledge your acceptance by signing below.
- I agree to fully attend the Annual and the Interim meetings
- I acknowledge that I am responsible for securing time off with my program director to attend these meetings to fulfill my duties as an RFS Sectional Delegate or Alternate Delegate
- I acknowledge that securing an endorsement does not imply funding. It is my responsibility to secure funding to attend the Annual and the Interim meetings
- I acknowledge that I have read the position description and understand the time commitment expectations
Please sign in the field below*

Clear

Click "submit" below to finalize and transmit your application. You will receive an email confirmation with a copy of your application and all submitted documents or files.

Please direct any questions to RFS@ama-assn.org.
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AMA-RFS Sectional Delegate and Alternate Delegate Nomination Form

Applicant information

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AMA-RFS Sectional Delegate and Alternate Delegate Application

Program Director information

Endorsement

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Acknowledgements