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PLI Application
Apply to the Physician Leadership Institute (PLI)
November 14 – 17, 2024 | Richmond, Virginia
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*
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I give my permission for the MSVF to send me text reminders related to PLI programming.
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How did you hear about PLI?
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Nomination
Other
If you chose nomination above, who nominated you?
Please list any memberships in local, specialty, state, or national medical associations.
*
Please list any leadership positions held in your practice setting, other organizations and/or in the community.
*
Describe your interest in the MSVF Physician Leadership Institute, including why you would like to participate (limit 500 words).
Describe the leadership traits you are seeking to develop (limit 250 words).
Upload CV
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Max. file size: 50 MB.
Release
I understand that by registering and attending a Medical Society of Virginia (MSV) event I grant the Medical Society of Virginia and its entities, and the agents and representatives of each organization, the absolute right and permission to use or disseminate the images resulting from the photography/video filming taken at the event/meeting, in whole or in part. I hereby authorize the use and dissemination of the materials referenced above without prior inspection or approval of the finished product, the advertising copy, or the use to which it may be applied. I hereby release from liability all of the entities reference above, together with their agents and representatives for the use or dissemination of the materials referenced above. I understand that I may be identified as the source of the content and that such use or dissemination will be public in nature.
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