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MSSI Membership Interest Form
Thank you for your interest in getting involved with MSSI. Please fill out the interest form below, and a member of the MSSI team will be in touch with you shortly! Questions? Email muilon79@rowan.edu
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Name
*
Your answer
Pronouns
*
Your answer
Email
*
Your answer
Phone Number
Your answer
Medical School or Graduate School (if applicable)
Your answer
Graduation Year (if applicable)
Your answer
Briefly tell us about your interest in and/or experience with size inclusive advocacy, if any. (Note - No prior experience is required for membership!)
*
Your answer
How did you hear about MSSI?
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Your answer
Committee(s) of Interest
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Curriculum
Community Engagement and Outreach (social media)
Research
Networking and Partnerships
Advocacy and Policy
Forming a new MSSI Chapter or Affiliate at your medical school*
Not sure
Other
Required
If other, please specify:
Your answer
Additional Comments / Questions / Concerns
Your answer
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