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Volunteer Participation Form for the Doctor's Dilemma℠ Competition at the ACP Internal Medicine Meeting 2016

ACP ID:

Name:*

E-Mail:*

Phone:*

Best way to contact me:*     E-mail    Phone

Please indicate your interest in and availability for each of the volunteer roles:*

Date and Time Judge Game Assistant Greeter
Thursday, May 5, 2016
2:30 p.m. to 6:30 p.m.
Friday, May 6, 2016
3:30 p.m. to 5:15 p.m.
Saturday, May 7, 2016
4:30 p.m. to 6:30 p.m.

Please briefly describe any similar past experience (volunteer or professional): *

* I understand that I must participate in a pre-meeting volunteer conference call in April, and an on-site volunteer training session at the ACP Internal Medicine Meeting 2016 in Washington, DC on Thursday, May 5, 2016 at 10:45 AM EDT.