Medical Advisory Committee Application
The National Lymphedema Network (NLN) Medical Advisory Committees (MACs) exist to assist in the drafting, editing and completion of NLN Position Papers.  To be considered for participation on a MAC, please complete this application.  All information will be kept confidential and will be reviewed by the MAC and NLN leadership.  Submissions will be reviewed within 14 business days on a revolving basis.  Applicants will receive a response via email within 14 business days.  Deadlines for applications to individual MACs can be found on the lymphnet.org website under the MAC page.  Please email nln@lymphnet.org with any questions.   

Thank you,
The National Lymphedema Network

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Personal and Professional Information
First Name *
Last Name
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Credentials *
Official Title *
Email *
Phone number *
Please upload your CV HERE in pdf format. *
Required
Please describe any current organizational affiliations with regard to your employment or other contractual relationships you may have.  Please include any organizations in which you serve as a board member, collaborating partner, faculty, speaker, or other role.  
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Please provide information regarding any industry or sponsor affiliations you may have which include financial or non-financial interests.
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MAC Choice(s)
Which Medical Advisory Committee(s) are you interested in joining? You may choose up to 3.  *
Required
Please provide a brief description of your qualifications to provide expertise on this topic: *
Are you currently doing research related to this topic?  If yes, please describe.  *
What is your motivation to participate?
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Acknowledgements
I acknowledge that I have fully read, understand, and agree with the MAC Policy and Procedure document.
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Required
I understand that MACs require a collaborative effort between all participating professionals, and as such I will maintain cooperative and interactive communications with the goal of achieving a consensus on the topic.  I will demonstrate professional conduct at all times.
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I agree to focus on the most current research and best practice standards on this topic without external influence, personal preference or prejudice.
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Required
If chosen to participate, I agree to work with other team members to schedule and attend meetings to allow for expedient completion of the project within the proposed timeframe. 
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I understand that all committee assignments are limited in scope, with all MACs being dissolved upon successful completion of the task. 
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I understand that participation in MACs is an at-will agreement between myself and the NLN.   I acknowledge that I may submit in writing my desire to cease participation, and that the NLN retains the ability to discontinue my participation in writing at the discretion of NLN leadership. 
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I acknowledge that any prepared materials will be subject to final approval by NLN leadership prior to publishing.  I acknowledge that the NLN retains all ownership and trademark rights of the prepared materials, and I agree not to share any materials with any other entities prior to publishing. 
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I acknowledge that participation will be acknowledged at the end of each Position Paper in alphabetical order,  publicly with speaking engagements, listing on the NLN website and other means. 
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I understand that my participation may be requested to present at conferences or other events about the completed paper, and I will endeavor to participate in these events if I am able to do so.
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Required
I understand that I will need to include references in Chicago style format.   *
Required
Please provide any additional information you would like to share.
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