2022-2023 SAEM Committee Interest Form

Sign up by October 15, 2021!

One of the most valuable benefits of membership in the Society for Academic Emergency Medicine (SAEM) is the opportunity to participate on one or more of the Society's committees. Serving on an SAEM committee furthers your professional development by providing leadership experience, expanding your professional network, and strengthening your ties within the specialty.

If you are eager to make a difference, committed to enhancing academic emergency medicine, and interested to play an important role in advancing the Society’s vision and mission, we invite you to review the SAEM committee descriptions and sign up for those that best match your interests and expertise.

The term of service for SAEM committees begins each year at the annual meeting in May and lasts for 12 months. To serve on an SAEM Committee, you must be a member in good standing and you must maintain your membership status during your committee term.

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* 1. Full Name (include middle initial, if applicable)

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* 2. Institution Name

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* 3. Professional/Institution Email Address

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* 4. Personal Email Address (This is used for accuracy/tracking in the SAEM database)

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* 5. Professional Category

Faculty

Fellow

Resident

Medical Student

Other (please specify)

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* 6. Please rank the committees you would like to join, with "1" being your top choice and "5" your last choice.

	1	2	3	4	5
Awards Committee	Awards Committee 1	Awards Committee 2	Awards Committee 3	Awards Committee 4	Awards Committee 5
Consultation Services Committee	Consultation Services Committee 1	Consultation Services Committee 2	Consultation Services Committee 3	Consultation Services Committee 4	Consultation Services Committee 5
ED Administration and Clinical Operations Committee	ED Administration and Clinical Operations Committee 1	ED Administration and Clinical Operations Committee 2	ED Administration and Clinical Operations Committee 3	ED Administration and Clinical Operations Committee 4	ED Administration and Clinical Operations Committee 5
Education Committee	Education Committee 1	Education Committee 2	Education Committee 3	Education Committee 4	Education Committee 5
Equity and Inclusion Committee	Equity and Inclusion Committee 1	Equity and Inclusion Committee 2	Equity and Inclusion Committee 3	Equity and Inclusion Committee 4	Equity and Inclusion Committee 5
Ethics Committee	Ethics Committee 1	Ethics Committee 2	Ethics Committee 3	Ethics Committee 4	Ethics Committee 5
Faculty Development Committee	Faculty Development Committee 1	Faculty Development Committee 2	Faculty Development Committee 3	Faculty Development Committee 4	Faculty Development Committee 5
Fellowship Approval Committee	Fellowship Approval Committee 1	Fellowship Approval Committee 2	Fellowship Approval Committee 3	Fellowship Approval Committee 4	Fellowship Approval Committee 5
Finance Committee	Finance Committee 1	Finance Committee 2	Finance Committee 3	Finance Committee 4	Finance Committee 5
Grants Committee	Grants Committee 1	Grants Committee 2	Grants Committee 3	Grants Committee 4	Grants Committee 5
Membership Committee	Membership Committee 1	Membership Committee 2	Membership Committee 3	Membership Committee 4	Membership Committee 5
Program Committee	Program Committee 1	Program Committee 2	Program Committee 3	Program Committee 4	Program Committee 5
Research Committee	Research Committee 1	Research Committee 2	Research Committee 3	Research Committee 4	Research Committee 5
Virtual Presence Committee	Virtual Presence Committee 1	Virtual Presence Committee 2	Virtual Presence Committee 3	Virtual Presence Committee 4	Virtual Presence Committee 5
Wellness Committee	Wellness Committee 1	Wellness Committee 2	Wellness Committee 3	Wellness Committee 4	Wellness Committee 5

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* 7. Please select the maximum number of committees you would like to be placed on.

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* 8. Brief Statement of Interest

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* 9. Are you planning to attend SAEM22, May 10–13, in New Orleans?

Yes

Unsure

Please click "Done" to submit your SAEM committee selections.