Take an Active Role in AES

AES currently has more than 30 Committees, Subcommittees and Task Forces. In addition to new task forces being formed, committee terms end, allowing new people to get involved. Your preferences are entered in a database and maintained for three years. We cannot promise placement but will do our best to get you involved. All committee placements are done based on the information you provide. Placements begin in the fall for 2009 Committees.

I have not been placed on a committee, but would like to be considered for a position in 2008.
I am already on a committee. Please list

YES, I would like to be considered for a volunteer position on a committee or task force. My preferences are indicated below as 1st, 2nd, and 3rd.

Committee 1st Preference:
Committee 2nd Preference:
Committee 3rd Preference:

I am also interested in getting involved in:
Special Interest Groups
Specific Area or Group:
Expert Panels or Editorial Review Boards
My Area of Expertise:
Local Epilepsy Foundation Professional Advisory
Board for (area/location):
I already participate in my local EF Professional Advisory Board for
Area/Location:

Special skills and areas of expertise that you possess: (Check all that apply)

Basic Research	Practice Management
Clinical Trials	Publicity/ Public Relations
Educational and Meeting Organization	Use of Technology/Computers
Financial/Investments	Speaker
Fundraising	Web site Development
Organizational Planning	Writing

What is your predominant professional activity? (Check all that apply)

Administration	Nursing
Adult Epileptology	Pediatric Epileptology
Adult Neurology	Pediatric Neurology
Basic Science Research	Pharmacology
Neuroimaging/EEG	Psychology/Behavioral Science/ Social Work
Neurosurgery	Other

Please use the following as my Primary Mailing Address Yes No

This is my Home Address Work Address

Name:
Degree:
Company:
Department:
My address has recently changed.
Address:
City:
State/Province:
Zip Code:
Country:
Work Phone:
Home Phone:
Fax:
E-mail:

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Please Note: Placements begin in the fall for 2008 Committees and Task Forces.

American Epilepsy Society

Take an Active Role in AES