AOA House of Delegates Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Address Line 1 *City *State *Zip Code *Phone Number *District *Number of Years in Practice *Specialty *AOA Number *I have paid my AOA & MAOPS membership dues (must be paid year applying and year serving) *YesNoI have served as an AOA Delegate in the last five years. *YesNoI would like to represent Missouri as a Delegate because. *If elected, I agree to abide by the expectations outlined below. *YesNoIf selected as a Missouri delegate, I am able to attend the entire AOA House of Delegates Meeting. If selected as a Missouri delegate to the AOA, I understand that I must meet the following expectations: I must be a current MAOPS member (both the year of application and year of service). I must proficiently use email and respond to requests promptly. I must attend a MAOPS AOA Delegate orientation meeting via conference call prior to the AOA House of Delegates. I must attend all MAOPS Caucus meetings at the AOA House of Delegates. I must serve on an AOA reference committee or attend a reference committee meeting as delegated by the Missouri Caucus chair. I must attend all sessions of the AOA House of Delegates. I am willing to review the resolutions and reports prior to the AOA House of Delegates. I am willing to be informed on the issues to be debated as I have a responsibility for establishing policies for the entire profession.Applicant Initials in Lieu of Signature *Recent professional headshot * Click or drag a file to this area to upload. Submit
