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Member Interest Form

Note: Fields marked with * are required.

Name *
Address *
City*
State*
Zip*
Email*
Specialty/ Sub-specialty

Please check all that are applicable:

Membership Status:

Master
Fellow
Member
Associate
Student

Serve on Committees:

Nominations: Governor's Council, Committee
Members, Member Recruitment
Credentials
Finance
Associate/Medical Student
Health and Public Policy
Awards: Laureate, Master Teacher, Distinguished Internist
Program: Annual Chapter Meeting
Diversity

Areas of Interest:

Clinical Vignette Competition

Mentoring
Judging

Organize group or round table discussions
Host special social/networking events
Moderate health/medical sessions at Chapter Annual Meeting
Present/lead discussions at Associate/Student educational activities
Assist with recruitment
Submit articles for ACP Iowa Chapter Newsletter

Advocacy

Serve on legislative advisory boards
Contact legislators on behalf of membership
Be a key contact person on a specific legislative topic
Topic

Regulatory

Monitor/comment on rule making
Serve on regulatory advisory boards
Meet with third party payor representatives e.g. health plans, Medicare

Contact Information

Scott A. Vogelgesang, MD FACP,
Governor, Iowa Chapter

Denise Floerchinger
Ph: 319-356-2732