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Voluntary Advisory Team
Erin Lombardo
2023-10-31T16:26:27+00:00
Voluntary Advisory Team
Interest Form
We are grateful for your enthusiasm in teaming up with us to bring proactive team-based care to everyone! Thank you for taking the time to fill out the voluntary advisory team interest form below.
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Where do you live?
(Required)
In US: City + State - Outside US: Country
Are you a Healthcare Professional?
(Required)
Yes
No
What type of Healthcare Professional?
(Required)
Physician
Athletic Trainer
Dietitian
Mental Health Counselor
Nurse
Nurse Practitioner or Physicians Assistant
Occupational Therapist
Physical Therapist
Social Worker
Other
What area do you specialize in?
I am a current or former college, professional or Olympic athlete who has experienced proactive team-based healthcare.
(Required)
Yes
No
What sport?
(Required)
I am inspired to share the following expertise/experience I have with the nonprofit, Partnership for Proactive Health.
(Required)
I am interested in volunteering time with the following:
(Required)
4th Trimester Care - Postnatal Care
Primary Care Model
Other
As a Voluntary Advisory Team member I am excited to accomplish the following over the next year:
While on the Voluntary Advisory Team, I will share time each month (~2 hours), read our email newsletter, attend at least 2 of 4 virtual meetings (Quarterly Sun or Tues @ 8pm ET) and join our campaigns to show proactive healthcare is necessary + desired!
(Required)
Yes
No
Please let us know if there is anything else you would like to share:
I would like to recommend a colleague or friend:
(Required)
Yes
No
Friend or Colleague's Name
(Required)
First
Last
Friend or Colleague's Email
(Required)
Please share any details on the friend or colleague you recommended
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