EMERGENCY MEDICINE LEADERSHIP SUMMIT 2021 Summit Registration Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Practice/Hospital Name State (if not in Maine) Question Title * 4. Check the category that best applies to you: I am an emergency department director. I am in a leadership position in my emergency department. I am interested in becoming an emergency department leader/director. I work in the emergency department I work in emergency services (Urgent Care, EMS, etc.) Other (please specify) Question Title * 5. Credentials or Degree MD / DO - FACEP MD / DO PA-C APRN / RN Emergency Medicine Administrator Other (please specify) Question Title * 6. Register me for: (check all that apply) Emergency Department Workforce Issues March 5, 2021 - 2:00 pm to 3:30 pmDr. Mark Rosenberg, MD, FACEP (ACEP President) and Susan Sedory, MA, CAE (ACEP Executive Director) Advocacy - Connecting with Stakeholders and Policy Makers for Change March 12, 2021 - 3:00 pm - 4:00 pm Tony Cirillo, MD, FACEP Innovations in Rural Emergency Department Staffing March 19, 2021 - 4:00 pm - 5:00 pmSpeaker TBA Question Title * 7. Comment or Note: REGISTER NOW!