2025 Section Election Nomination Form

2025 Section Election Nomination Form

If you are nominated or interested in serving for any position, you are required to fill out the CANDIDATE BIOGRAPHICAL SKETCH below so your section can make an informed decision when voting during elections. Deadline is September 21
Name:*

First NameLast Name
Email:*
Will not be shared, just for internal PAMED use
City/Town:*
What Position are you running for:*

How long have you been a PAMED member?*
Medical College:*
Year Graduated:*
Board Certification*
Specialty:*

County Medical Society
Current Positions*
Former Positions*
Pennsylvania Medical Society
Current Positions*
Former Positions*
American Medical Association
Current Positions*
Former Positions*
Specialty Societies or Other Positions
Current Positions*
Former Positions*
Other related activities *
i.e. medical community service - health missions, free clinics

Are you a member of PAMPAC?*

YesNo
Are you a member of any other Medical Association PAC's? (like AMPAC)*

YesNo
Have you ever donated to The Foundation?*

YesNo

Would you like us to include a photo of you?

Browse Files

Cancelof
Would you like to upload a campaign video

Browse Files

Cancelof
Why should you be elected to this position*

in 500 characters or less0/500
Should be Empty: