Network Application - Trauma Emergency Medicine

Trauma Emergency Medicine Network

Membership Application
Full Name*

First NameLast Name
Email*
example@example.com
ACEM membership number
What is your primary professional classification?*

FACEMACEM TraineeACEM CertificantACEM DiplomateACEM Advanced DiplomateACEM SIMGAllied Health WorkerMedical AdministrationMedical Officer/InternNursing StaffOther Specialty ConsultantOther Specialty TraineeParamedicResearch Staff
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 ZealandAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
City/Town of residence *
Primary place of employment *
Are you undertaking research related to Trauma Emergency Medicine?*

YesNo
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*

YesNo
By submitting I agree to receive news of TEMN activities and actively contribute to the Network.
Should be Empty:

Trauma Emergency Medicine Network