2025-2026 Committee Application Form

2025 - 2026 Committee Application Form
Application Deadline: April 14, 2025

Committees play a vital role in the Society’s work to build a strong specialty. We rely upon our membership to carry out the essential work of the committees and value the service of the committee volunteers. Each term of service is two years.
- Active, Candidate, and Associate Members are eligible to serve on all committees.
- Surgeon-in-Training Members may serve as ex-officio committee members on one committee.
- International Members are eligible to serve on most committees; these are marked with an *.
- Allied Health/Associate-Basic Science Members may serve on select committees; these are marked with an #.
TERM OF SERVICE NOTES:
- Current members on a committee whose term of service is ending in 2025 who wish to request re-appointment to that same committee do not need to submit a committee application. Please notify the AOFAS offices (at CmtApp@aofas.org) that you wish to serve another term (or choose the "Yes" option under the committee choice selections below).
- Terms of Service: Committee Chairs are appointed to a two-year term and may serve up to two (2) terms. Committee Vice Chairs are appointed to a one-year term and may serve up to two (2) terms.
- For the Young Physicians Committee only, Committee Chairs are appointed to a one-year term. Vice Chairs are appointed to a one-year term and then may elevate to Committee Chair. The past Committee Chair will remain on the committee for one year as an ex-officio member.

COMMITTEE(S) OR POSITION(S) FOR WHICH YOU ARE APPLYING OR WISH TO BE CONSIDERED:
NOTE: Eligibility for the Young Physicians Committee is limited to members who have been in practice for 10 years or less.

You may apply for up to three (3) committees:
1. First Choice Committee Name
If currently on this committee, are you re-applying for another term on it?

YesNo
2. Second Choice Committee Name
If currently on this committee, are you re-applying for another term on it?

YesNo
3. Third Choice Committee Name
If currently on this committee, are you re-applying for another term on it?

YesNo

PERSONAL INFORMATION
Name

PrefixFirst NameLast NameSuffix
Work Address
City
State
Zip
Country
Work phone

Country CodeArea CodePhone Number
Cell phone

Country CodeArea CodePhone Number
E-mail address
example@example.com
Secondary e-mail (optional)
example@example.com
What is your gender identity?
What is your racial or ethnic identity?

EDUCATION AND TRAINING
Medical School
Dates Attended
Enter To / From dates
Residency
Dates Attended
Enter To / From dates
Fellowship
Dates Attended
Enter To / From dates
Other Training (if applicable)
Dates Attended
PRESENT OR PAST APPOINTMENTS, SERVICE, AND EXPERIENCE WITH AOFAS Examples: committee service, course faculty, etc.
PRESENT OR PAST SERVICE TO OTHER MEDICAL ORGANIZATIONS, JOURNAL, ETC.
OTHER RELEVANT EXPERIENCE – Please list relationships you have with national or state level decision makers.
OTHER QUALIFICATIONS, SPECIAL TRAINING, OR EXPERTISE
ONE PARAGRAPH STATEMENT OF YOUR GOAL AND WHY YOU ARE WELL-SUITED FOR THIS POSITION
OTHER COMMITMENTS – Briefly note other commitments that may represent potential conflicts with your ability to fulfill your commitment for this position. If there are no other commitments, please state “none”.

AGREEMENT – I understand and agree to meet the commitments that this position entails, including participating in conference calls, attending meetings, actively contributing to discussion, providing timely responses, supplying reports, etc.

I understand that if selected I will be required to sign the “Committee Commitment” Form on the next page. This commitment will only be in effect if I am selected to serve so I return this signed form along with my application in good faith.
Signature

Clear
Date

MonthDayYear
Date
Thank you for your interest in participation and service to AOFAS.

Press "submit" to complete the submission process. Or you may e-mail your completed form to cmtapp@aofas.org. All submissions must be received no later than April 14, 2025.

Questions? Please call 847-698-4654

Thank you!

2025-2026 AOFAS Committee Commitment Agreement
As a member of an AOFAS Committee, I understand I am in a leadership position and affirm the following:

1. I am a current AOFAS Member in good standing as required by the Bylaws.

2. I will meet the commitments this position entails, including participating in conference calls, attending meetings, reviewing materials, contributing actively, providing timely responses, supplying reports, evaluations, etc.
- Committees are to meet a minimum of 4x/year and all members will commit to a minimum attendance of 50% of these meetings.
- All Committee members will commit to serve and support the AOFAS Board of Directors.
- All Committee members will commit to serve and support the philanthropy mission of the Foundation.
- All Committee Chairs will submit a written report of activities to the BOD and Board Liaison prior to the semi- annual retreat.
3. I will maintain a current (within 6 months) AOFAS Disclosure form.

Failure to comply with this commitment agreement will be reviewed by the AOFAS Committee on Committees. Statement approved by the AOFAS Board of Directors, October 2018.
Signature

Clear
Print Name
Date

MonthDayYear
Date
For questions, contact Pat Heiberger at cmtapp@aofas.org
Should be Empty:

2025 - 2026 Committee Application Form

COMMITTEE(S) OR POSITION(S) FOR WHICH YOU ARE APPLYING OR WISH TO BE CONSIDERED:

PERSONAL INFORMATION

EDUCATION AND TRAINING

2025-2026 AOFAS Committee Commitment Agreement