Biographical Sketch Form - American Medical Association



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|AMA Senior Physicians Section Governing Council Candidate |

|BIOGRAPHICAL SKETCH |

|Please follow this format. The form will appear on the SPS website |

|and on the ballot for public viewing. |

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|Full Name: |Current Position/Title: |

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|Education/Training: (Begin with initial professional education, medical school, and include postdoctoral training.) |

|INSTITUTION AND LOCATION |DEGREE |YEAR(s) |FIELD OF STUDY |

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NOTE: Biographical Sketch may not exceed two pages.

A. Leadership Positions:

B. Organized Medicine (Medical Associations) Memberships and Experience:

C. Honors/Awards:

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