Form LIP -- Leadership Identification Program Questionnaire

Name

AAPA #

Address

City, State, Zip

Phone

E-mail

Are you interested in volunteering at the national level?

Yes

Tell us about your strengths and skills (e.g., detail-oriented, writing, editing, public speaking, accounting, etc.)

Are you currently volunteering for a constituent organization?

Yes

If yes, which one(s)?

Tell us about your interests (e.g., CME planning, governance, PA practice issues, Congressional Visits Program, etc.).

If you are interested in volunteering with a constituent organization, consider participating in the Constituent Organization Leader Recruitment (COLOR) program. Fill out this application (http://www.formsite.com/aapa/form084115864/index.html) and AAPA staff will help you make your first connection with the constituent organization of your choice. If you have questions about the program please contact Kodi Blue Erb, 703/836-2272, ext 3127, kerb@aapa.org.