Paediatric Emergency Medicine Network
Membership Application
Name
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First Name
Last Name
Email
*
ACEM membership number
What is your primary professional classification?
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FACEM
ACEM Trainee
ACEM Certificant
ACEM Diplomate
ACEM Advanced Diplomate
ACEM SIMG
Allied Health Worker
FRACP
Medical Officer/Intern
Nursing Staff
Other Speciality Consultant
Other Speciality Trainee
Paramedic
PEM Specialist (FACEM or FRACP)
Are you either of the following? (Select One)
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Director of Emergency Medicine (DEM)
Director of Emergency Medicine Training (DEMT)
Neither of the above
Country/State (Select One)
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Aotearoa New Zealand
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
City/Town of residence
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Primary place of employment?
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e.g. Auckland City Hospital
Are you a member of any research networks? (Optional - select all that apply)
ACEM Clinical Trials Network
ACEM Emergency Department Epidemiology Network
Australasian Society for Infectious Diseases Clinical Research Network
Australasian Stroke Trials Network Australia & New Zealand
Australian & New Zealand College of Anaesthetists Clinical Trials Network
Australian & New Zealand Intensive Care Society Clinical Trials Group
Australian Paediatric Research Network
New Zealand Emergency Medicine Network
Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Other Colleges/professional organisations with which you are associated (Optional - select all that apply)
Advanced Paediatric Life Support Australasia (APLSA)
Australasian College of Dermatologists (ACD)
Australasian College of Anaesthetists (ANZCA)
Australian College of Nursing (ACN)
Australian College of Nurse Practitioners (ACNP)
Australian College of Critical Care Nurses (ACCCN)
Australian College of Rural and Remote Medicine (ACRRM)
Australasian College of Sports and Exercise Physicians (ACSEP)
College of Emergency Nursing Australasia (CENA)
College of Intensive Care Medicine (CICM)
College of Nurses Aotearoa (NZ)
Health Informatics Society of Australia (HISA)
International Federation of Emergency Medicine (IFEM)
Nurse Practitioners New Zealand (NPNZ)
Paramedics Australasia (PA)
Royal Australian and New Zealand College of Ophthalmologists (RANZCO)
Royal Australian and New Zealand College of Psychiatrists (RANZCP)
Royal Australian College of General Practitioners (RACGP)
Royal Australasian College of Obstetricians & Gynaecologists (RANZCOG)
Royal Australasian College of Medical Administrators (RACMA)
Royal Australasian College of Physicians (RACP)
Royal Australian and New Zealand College of Psychiatrists (RANZCP)
Royal Australasian College of Surgeons (RACS)
Royal Australasian College of Radiologists (RANZCR)
Royal College of Pathologists of Australia (RCPA)
Royal New Zealand College of General Practitioners (RNZCGP)
I agree to receive PEMN news by email
*
Yes
No
By submitting I agree to receive news of PEMN activities and actively contribute to the Network.
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