YPS Endorsement Selection Committee Application
Name
*
First Name
Last Name
State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Specialty society
*
Will you still be a YPS member in 2026?
*
Yes
No
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Campaign Involvement Form
1. Are you planning to serve on any campaigns for 2027?
*
Yes
No
2. If yes, please select which race you will be participating in:
President
Speaker
Vice Speaker
Board of Trustees
Young Physician seat on the BOT
Elected Councils
Other
3. If you are participating in an Elected Councils race, please specify which council:
Submit
Should be Empty: