Training Program (i.e. Internal Medicine)

place field "CurrentYear" below

Current Year (i.e. PGY-1 or PGY-6)

place field "GradYear" below

Graduation Year

place field "ContactPhone" below

Contact Phone Number (to be added to WhatsApp Group)

place field "Address" below

Hometown City, and State (i.e. Hempstead, NY)

place field "Birthday" below

Birth Month and Day (i.e. October 31)

place field "Affiliations" below

Your Program and/or Department Affiliations and Position/Title (i.e. Jane Doe, Obstetrics and Gynecology Residency, PGY-3 or John Smith, Med-Peds, Program Director

place field "Representation" below

Department or Organization You Are Representing

place field "Position" below

Your Position or Title with the Department or Organization

place field "Ethnicity" below

Upon completion of this form, you will receive a “Terms of Agreement” form with additional information about the role of an affiliate, the expectations, and the advantages of being one. After reviewing that document, you will be asked to sign a commitment pledge that will serve as a contract that will be reviewed by AMRF leadership annually.

The Association for Minority Residents and Fellows is committed to creating a culturally diverse and inclusive environment for underrepresented trainees. As such, we ask that you please provide us with the demographic information requested below for data collection. You are not required to provide this information, but you are encouraged to do so, as doing this will allow us to ensure that we are appropriately meeting the needs of all of our members.

Association of Minority Residents & Fellows (AMRF)

Join Us!