Bringing Science to Your Community

Bringing Science to Your Community
The AHA needs professionals like you to talk about the importance of research funding to local boards, donors, and event participants. Will you help teach people in your community about your work, the impact of AHA funding on research outcomes, and the importance of the AHA to science and medical professionals?

Please complete the form below with as much detail as possible, so we can connect you to the most appropriate opportunities. Thank you for your continued support of the AHA/ASA.
How it Works

1. AHA Research Alumni and Professional Members who are willing to participate in local opportunities complete this form.

2. We will contact you when a local activity is planned to ask if you wish to participate.

3. The AHA will follow up after the activity to ask for your feedback to post on the Researchers at Heart alumni news website.
Name*

First NameLast NameDegree(s)
E-mail*
example@example.com
Phone Number*
Address - Either work or home, so that we can match you with activities closest to the location you prefer*

Street Address

Institution (If Applicable)

CityState / Province

Postal / Zip Code
Additional Address - Either work or home, so that we can match you with activities closest to the location you prefer

Street Address

Institution (If Applicable)

CityState / Province

Postal / Zip Code
AHA Status (check all that apply)

Current or Previously Funded ResearcherProfessional MemberOther
Career Level

Student/TraineeEarly CareerMid-CareerTenured/Senior CareerDirector/Department HeadOther
Job Classification (select all that apply)

PhysicianScientist/ResearcherStudent/TraineePharmacistNurseAdministratorOther Healthcare ProfessionalNon-Healthcare ProfessionalOther
Area of Expertise
Please enter your specialty
Professional Volunteer Opportunities That Most Interest You (select all that apply)

Addressing participants at an AHA event (i.e., Heart Ball, Go Red for Women Luncheon)Research presentations to smaller groups (i.e., Board Meetings, Executive Leadership Team Meetings)Speaking engagements at schools, college clubs, and outside groups aligned with AHATour of your Research LabAdvocacy engagement with your local or state legislatureOther
Do you have any conflicts of interest with other organizations or companies?*

YesNoUnsure
If you answered "Yes" to the previous question, please give details.
Preferred Day (select all that apply)

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Preferred Time (select all that apply)

MorningEarly AfternoonLunch TimeLate AfternoonEveningOther
Please add any additional information you wish to provide.
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