Trauma Emergency Medicine Network
Membership Application
Full Name
*
First Name
Last Name
Email
*
example@example.com
ACEM membership number
What is your primary professional classification?
*
FACEM
ACEM Trainee
ACEM Certificant
ACEM Diplomate
ACEM Advanced Diplomate
ACEM SIMG
Allied Health Worker
Medical Administration
Medical Officer/Intern
Nursing Staff
Other Specialty Consultant
Other Specialty Trainee
Paramedic
Research Staff
Other
Are you any of the following?
*
Director of Emergency Medicine (DEM)
Director of Emergency Medicine Training (DEMT)
None of the above
Country/State
*
Aotearoa New Zealand
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Other
City/Town of residence
*
Primary place of employment
*
Are you undertaking research related to Trauma Emergency Medicine?
*
Yes
No
Please tell us about any special interests you have that may be relevant to this network for instance trauma-related research.
I agree to receive TEMN news by email
*
Yes
No
By submitting I agree to receive news of TEMN activities and actively contribute to the Network.
Submit
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