Co-Chair Volutneer form – Medical Affairs Professional Society

Co-Chair Volunteer Form

Name(Required)

First Last

Email(Required)

Company Name

Professional Title

Years of Medical Affairs Experience

Briefly explain why you would be successful Co-Chair for the conference?

Are you a MAPS Member?

Yes

No

Do you have any commitments that you are aware of that would make you unavailable for an extended time (More than 2 weeks) over the next year?

Yes

No

If yes, please explain