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Member Community Online Application

Physiatrist Member Community Online Application

AAPM&R physiatrist members of all different backgrounds and experiences have a new way to connect with each other—AAPM&R Physiatrist Member CommunitiesMember Communities are self-identified, organically established communities offering opportunities for physiatrist members to connect with each other, share experiences, and advance the future of the specialty together!
AAPM&R Physiatrist Member Communities can be:
  • Clinically focused (i.e., stroke, sports medicine, etc.)
  • Practice focused (i.e., inpatient rehabilitation, etc.)
  • Identity focused (i.e., women physiatrists, etc.)
The focus and goals of the community are up to you and your peers! You simply need to complete the application process, which requires your community goals and a minimum of 10 community members who are AAPM&R physiatrist members.
1. Please provide complete current contact information for who is submitting the application for a new Member Community.
2. Are you a current member of the Academy?
6. What type of Member Community is this?
7. In order for the Academy to best help the Physiatrist Member Community, an Interim Chair must be nominated.  The Interim Chair will be the main contact for the Academy for questions regarding the application, member community recruitment, and the leadership election process.  The term for the Interim Chair will be from the time the application is submitted until the inaugural election is completed.   *This question is required.
8. Has the above named Interim Chair been contacted and approved this nomination? *This question is required.
9. A minimum of 10 Academy Physiatrist members are needed to apply for a Member Community. Please list their names below. Feel free to utilize the Member Directory to identify member names and email addresses.
Space Cell Full NameCompanyEmailCell Phone
Member 1
Member 2
Member 3
Member 4
Member 5
Member 6
Member 7
Member 8
Member 9
Member 10
Member 11
Member 12
Member 13
Member 14
Member 15
10. I have contacted each member on this application to ensure that he/she would like to join this member community. *This question is required.