1.Please enter your name.

2.Please enter your e-mail address.

3.Please describe the project or idea that you'd CalACEP to undertake.

4.How is this project or idea related to CalACEP's Strategic Priorities?

5.What do you envision the timeline being for implementing/doing this project?

6.What kind of structure do you envision for making this project a reality? A solo effort, small group, task force, or committee? More staff-driven or physician-driven?

7.How much do you estimate this project or idea to cost?

8.Is there a budget item or category in the current budget to support this proposal?

9.Who do you envision as the primary audience for this program?

Regular Members (More than 3 years out of residency)

Transitioning Members (Within 3 years of residency)

Residents

Medical Students

The public

Policy-makers (Governor, legislators, regulators, etc.)

Non-Member Emergency Physicians

Other Physicians

Advance Practice Providers (NPs, PAs, RNs, etc.)

Chapter leadership (Board, Councillors, committee members, etc.)

Other (please specify)

10.What do you think the return on investment for CalACEP resources might be? It doesn't necessarily mean money; it could be higher retention rates or intensity of feeling about membership, for example.

11.Please add anything else that you think is important to understanding your proposal.