2023 Membership Advisory Group Application
Answers marked with a * are required.
1. Section I: Applicant Information
  Please complete this application to be considered for a role on the American Diabetes Association’s Membership Advisory Group. A completed application form must be received by November 6, 2023 at 11:59 p.m. ET to be considered.
Purpose:

The Membership Advisory Group provides expert guidance on the American Diabetes Association’s (ADA’s) Professional Membership Initiative. This group will oversee the development and enhancement of ADA’s Professional Membership benefits and strategies. The ADA's Membership Advisory Group meets regularly to develop strategies for enhancing the professional membership experience, including Interest Group engagement, professional awards, and networking opportunities.

Qualifications for Membership:
ADA Professional Member volunteers that represent the multidisciplinary diabetes care team as well as those who represent the research community will be eligible for service on this group.

Advisory Group Charges and Responsibilities:

- Review membership benefit offerings and serve as a sounding board for new benefit ideas
- Vote on applicants for membership-based leadership teams
- Develop the long-term mission of and engagement strategies for ADA’s Interest Groups
- Review membership marketing and communication materials targeting diverse audiences
- Provide insights regarding successful membership management, revenue, growth, and engagement used by related organizations
- Serve as a liaison to Interest Groups by connecting with the Leadership Team on a frequent basis

Advisory Group Commitment:
- Monthly conference calls (60 minutes)
- Regular email communication with the other members of the Membership Advisory Group, via the DiabetesPro Member Forum
- Two-year term (January start)
- One meeting per year at ADA’s Scientific Sessions
- Regular email communication and/or attendance at Interest Group monthly meetings

More information about the Membership Advisory Group can be found at https://professional.diabetes.org/MAG
 
1. Applicant name: *
 
 
 
2. Current Title and Credentials: *
 
 
 
3. Current Place of Employment including city and state: *
 
 
 
4. Please provide your email address. *
 
 
 
5. Gender *
      
 
 
 
6. Age *
      
 
 
 
7. Race (choose all that apply) *
       		 
 
 
8. Ethnicity *
      
 
 
 
9. Are you an American Diabetes Association member? *
      
 
 
 
10. How many years have you worked in the field of diabetes? *
      
 
 
 
11. What is your primary profession? *
      
 
 
 
12. What is your primary medical specialty (or the practice you work for)? We define your primary specialty as the one in which you spend the most hours. *
      
 
 
 
13. What type of research do you conduct? *
      
 
 
 
14. What are your areas of focus in your clinic and/or research? (Select all that apply) *
       		 
 
 
15. Please briefly describe your professional and academic background and other relevant experience. Note: Field maximum is 1,500 characters. *
 
 
 
16. Please outline the specific skills, expertise, and connections you bring and are willing to use on behalf of the American Diabetes Association in this capacity. Note: Field maximum is 1,500 characters. *
 
 
 
17. Please select any current or past ADA Committees/ Advisory Groups on which you have served
       		 
 
 
18. Please select any of your current or past ADA contributions
       		 
 
 
19. Can you commit to attending monthly virtual meetings? *
      
 
 
 
20. Can you commit to spending 1-2 hours per week in this role? *
      
 
 
 
21. As a resident of countries affected by GDPR, we are required to request your consent and acknowledgement that you authorize us to store your data by checking this box. To read and understand the ADA’s Privacy Policy, please visit: https://diabetes.org/about-us/policies/privacy-policy *