2018-2019 RAMS Committee Interest Form

Personal Information

As a committee member of RAMS, you will play a crucial role in influencing the direction of the Society at large and charting the course for the future of emergency medicine. Operating under the leadership of the RAMS Board, and with full support from the entire SAEM leadership, you will help develop future educational solutions that address the needs and wishes of residents and medical students. The 2018-2019 term of service for committees will begin in July 2018 and end at SAEM's Annual Meeting in May 2019.

We invite you to review the 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 selections will be sent out in the beginning of July 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. Personal Email Address (This is used for accuracy/tracking in the SAEM database):

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* 5. What is your professional category?

Resident

Medical Student

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* 6. Please select up to 2 committees you would like to join, with 1 being your top choice and 2 your second choice. If you have questions about a particular committee, please review the committee descriptions. Please note that you will only be appointed to one committee.

	1	2
Awards Committee	Awards Committee 1	Awards Committee 2
Education Committee	Education Committee 1	Education Committee 2
Membership Committee	Membership Committee 1	Membership Committee 2
Mentorship and Career Development Committee	Mentorship and Career Development Committee 1	Mentorship and Career Development Committee 2
Nominating Committee	Nominating Committee 1	Nominating Committee 2
Research Committee	Research Committee 1	Research Committee 2
Social Media and FOAM Committee	Social Media and FOAM Committee 1	Social Media and FOAM Committee 2
Wellness Resilience Committee	Wellness Resilience Committee 1	Wellness Resilience Committee 2

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* 7. Brief Statement of Interest: (optional)

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* 8. 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 RAMS Committee Interest Survey. Notifications for committee appointments will go out at the beginning of July 2018.

Please click on done to submit your selections.