Data Collection for Education Team Page

Welcome!

We’re honored to feature your expertise as part of our SAFM Education Team.

Please take a few minutes to share your headshot and professional details so we can include you on our public team page.

Note: We may lightly edit your responses for clarity or formatting before publishing.

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Personal Information

Name(Required)

How should your name appear on the SAFM Education Team page?

First Last

Professional / Credential Acronyms (optional)

List any credentials you’d like displayed after your name (e.g., MD, CNS, IFMCP).

Final Name Display Confirmation (with acronym):(Required)

Please confirm how your name (with any credentials) will appear on the SAFM Education Team page. If anything looks off, feel free to edit the fields above before submitting.

,

Yes, this is exactly how I’d like my name to appear.

Final Name Display Confirmation (without acronym):(Required)

Please confirm how your name will appear on the SAFM Education Team page. If anything looks off, feel free to edit the fields above before submitting.

Yes, this is exactly how I’d like my name to appear.

Let's showcase your passions

What’s something you’re especially passionate about in your work?(Required)

This could be a specific topic in functional medicine, a student experience you love supporting, or something that lights you up in clinical education.

What’s something you love outside of work that brings you joy or fulfillment?(Required)

We love sharing the whole human! Feel free to tell us about a hobby, passion, or personal interest that brings you energy or meaning.

A little more about you

Professional Title or Company Name:(Required)

What’s your current title or the name of your company?

Website or Webpage (Optional):

Want to share a website where visitors can learn more about your work?

Let's now put a face to the name

High Resolution Headshot(Required)

Upload a clear, high-quality headshot (JPG or PNG). Ideal size is at least 1200px wide. Make sure the photo is well-lit, in focus, and shows your face clearly with minimal background distractions.

Max. file size: 2 GB.