1.Please provide your contact information below:

Name

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

2.What is your gender?

Female

Male

I prefer not to answer

Other (specify)

*3.What is your field of study?(Required.)

4.Please list any previous activities with ASM (volunteer, webinars, events, etc.)

5.How would you describe your social media knowledge?

Far above average

Above average

Average

Below average

Far below average

6.How often do you use ASM Connect?

Every day

A few times a week

About once a week

A few times a month

Once a month

Less than once a month

7.Please state any social media experience (professional)

8.How many hours could you commit to volunteering in ASM Connect?

3 hours per week

2 hours per week

1 hour a week

less than 1 hour a week

*9.Please provide two professional references and their contact information(Required.)

Reference 1

Reference 2

10.Please upload your CV

Choose FileNo file chosen

11.ASM Connect is segmented into 8 Networks (or forums), each corresponding to a Microbiology scientific track. Which track interests you the most? You can select more than one. 

Antimicrobial Agents and Resistance (AAR)

Clinical Infections and Vaccines (CIV)

Ecology, Evolution and Biodiversity (EEB)

Molecular Biology and Physiology (MBP)

Applied and Environmental Science (AES)

Clinical and Public Health Microbiology (CPHM)

Host-Microbe Biology (HMB)

Profession of Microbiology (POM)

12.How did you find out about this volunteer position?

ASM.org website

ASM Connect 

Email Newsletter

Referral from another ASM member

Other (please specify)

13.Why are you interested in volunteering for the ASM Connect Community Champion role? Select all that apply.

Network with peers

Collaborate with other members

Share my work

Ask questions and/or request for opinions

Stay up-to-date with microbiology news

Gain science communication skills

Other (please specify)