School of Medicine & Dentistry / Office of Equity and Inclusion / Groups & Resources / Medical Center / AMRF / Join Us! Join Us! Interested in becoming a member, ally, or affiliate? Please complete the following form to join our organization. First Name*: Last Name*: Email Address*: I Am Interested in Becoming a*: MemberAllyAffiliate Training Program (i.e. Internal Medicine): Current Year (i.e. PGY-1 or PGY-6): Graduation Year: Contact Phone Number (to be added to WhatsApp Group): ( ) - Second three digits Last four digits Hometown City, and State (i.e. Hempstead, NY): Birth Month and Day (i.e. October 31): 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: Department or Organization You Are Representing: Your Position or Title with the Department or Organization: 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. Ethnicity (Check All That Apply): Hispanic or LatinoNot Hispanic or LatinoI Do Not Wish to Provide This Information Race (Check All That Apply): American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther (Please Specify)I Do Not Wish to Provide This Information Please Specify: *Required Our Privacy Policy For more information, or for additional questions please email AMRF@urmc.rochester.edu.