I-2025 HOD Committee Volunteer Form

NOVEMBER 2025 HOD COMMITTEE VOLUNTEER FORM
This form is to be completed by volunteers for reference committees (other than F), the Rules & Credentials Committee, and tellers for I-25. Please indicate all positions which you would be interested in serving. You may make multiple individual selections or choose “ANY” if you are open to serving where needed.

Preference will be given to those who have not recently served; however, all interested are encouraged to apply. Those who currently serve on AMA councils will not be considered for service to allow for leadership opportunities for others.

Reference committees will meet virtually sometime between Friday, October 31 and Thursday, November 6, 2025 to develop their Preliminary Reference Committee Reports based on testimony received online. We ask that all who are interested in serving on reference committees hold that week open to accommodate these meetings.
Are you available to meet sometime between Friday, October 31 and Thursday, November 7, 2025, if selected to serve on a reference committee?*

YesNo
Would you like to Chair a committee? (previous service on a committee required)

Yes
Name*

First NameLast Name
Email*
example@example.com
State*
Mobile Number*

Area CodePhone Number
Specialty*
Please select one*

DelegateAlternate DelegateRegional Medical Student DelegateRegional Medical Student Alternate DelegateSectional Resident DelegateSectional Resident Alternate Delegate
Name of the society or section you represent in the House of Delegates*
Are you currently serving on an AMA Council?

YesNo
Which AMA Council are you serving on?*
HOD Committees*

E&B - Ethics and BylawsB - Legislative AdvocacyC - Advocacy on Medical EducationJ - Advocacy on Medical Practice, Service and InsuranceK - Advocacy on Science and Public HealthRC - Rules and Credentials CommitteeT - Assistant TellerAny
Previous AMA HOD Committee Service*
Please list previous AMA HOD COMMITTEE experience and indicate if you chaired a committee.
Statement of Interest*
Not to exceed 150 words.
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If you have questions or require additional information please contact Patti Wargo, Office of House of Delegates Affairs at patti.wargo@ama-assn.org or 312-464-4463.
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NOVEMBER 2025 HOD COMMITTEE VOLUNTEER FORM