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2021-2022 ADIEM Committee Interest Form
*
1.
Full Name
(Required.)
*
2.
Institution Name
(Required.)
*
3.
Professional/Institution Email Address
(Required.)
4.
Personal Email Address
(This is used for accuracy/tracking in the SAEM database)
*
5.
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
.
(Required.)
1
2
3
Accommodations Committee
1
2
3
Awards Committee
1
2
3
Education Committee
1
2
3
LGBTQ+ Committee
1
2
3
Nominating Committee
1
2
3
Research Committee
1
2
3
Resident and Student Committee
1
2
3
Social Media and Publications Committee
1
2
3
Thank you for completing the 2021-2022 ADIEM Committee Interest Form.
Please click on done to submit your selections.
