2018-2019 AACEM Committee/Workgroup Interest Form

2018-2019 AACEM Committee and Workgroup Interest Form

With support and leadership from the AACEM Executive Committee, committee and workgroup members play a role in influencing the direction of AACEM and charting the course for the future of academic emergency medicine. The 2018-2019 term of service for committees and workgroups will begin in July 2018 and end at SAEM's Annual Meeting in May 2019.

We invite you to review the workgroup and committee descriptions and select which ones are of greatest interest to you. Please note that we will make every effort to assign you your primary choice, but due to the popularity of some committees, we cannot provide a guarantee. Notification of committee and workgroup selections will be sent out in the beginning of July 2018.

Submission are due by Monday, June 18, 2018.

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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. Please select up to 3 committees you would like to join, with 1 being your top choice and 3 your last choice. If you have questions about a particular committee, please review the committee descriptions.

	1	2	3
Membership Committee	Membership Committee 1	Membership Committee 2	Membership Committee 3
Nominating Committee	Nominating Committee 1	Nominating Committee 2	Nominating Committee 3
Professional Development Workgroup	Professional Development Workgroup 1	Professional Development Workgroup 2	Professional Development Workgroup 3
Networking Workgroup	Networking Workgroup 1	Networking Workgroup 2	Networking Workgroup 3
Library of Resources Workgroup	Library of Resources Workgroup 1	Library of Resources Workgroup 2	Library of Resources Workgroup 3

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* 5. Brief Statement of Interest: (optional)

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* 6. Do you plan on attending ACEP's 2018 Scientific Assembly from October 1-4 in San Diego, CA?

Yes

Unsure

Thank you for completing the 2018-2019 AACEM Committee and Workgroup Interest Survey. Notifications for committee and workgroup appointments will go out at the beginning of July 2018.

Please click on done to submit your selections.