CPC Judges Confirmation Form

2023 National EM CPC Task Force Judges Confirmation Form

Deadline for acceptance is October 23, 2022
Participating in the 2023 CPC Task Force means:

Preliminary Competition Timeline
- December 9, 2022 – January 6, 2023 - Review and score assigned cases, submit scores to CORD as requested.
Semi-Final Competition
- Competition Days, the afternoon of Tuesday March, 21, 2023 & morning of Wednesday March 22, 2023
- Meet immediately prior to the CPC Competition for a CPC Briefing that includes meeting your team and your team leader
- Judge and score the Semi-Final Competition in conjunction with the 2023 CORD Academic Assembly:
- Attend the Awards Ceremony to watch the presentation of your Division’s winners: TBD
Thank you for your willingness to volunteer and participate. Should you have any questions or concerns, please contact the CORD office or the 2022 CPC Task Force Chairs directly, Katrin Takenaka or Greg Polites.
Judge Information

The information below will be used to contact you regarding the competition and your name will be displayed exactly as entered below on all materials for the competition.
Full Name *

First NameLast NameDegree
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Program Name*
Program City and State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Chair/Dean Information

We would love to send a letter to your Chair or Dean recognizing you for your participation as a judge for a national competition. Please complete the information below telling us who to address your letter to and where the letter should be sent.
Chair/Dean Full Name*

First NameLast NameDegree
Chair/Dean Email*
example@example.com
Chair/Dean Program Name*
Chair/Dean Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By submitting this form, you agree to the following:

I confirm my participation as a member of the 2023 CPC Task Force and serve as a judge for the 2023 National Emergency Medicine CPC Semi-Final Competition. I am available and agree to score the cases in the preliminary round and can score my cases by January 6, 2023, deadline. I will be available at the CORD 2023 Academic Assembly from 12 pm to 6 pm on March 21, 2023, and 7 am to 1 pm on March 22, 2023 (all times are Pacific). I understand that by participating as a judge I am not able to participate as my programs Faculty Discussant or speak at a session during the competition days/hours listed above.
Should be Empty:

2023 National EM CPC Task Force Judges Confirmation Form

Judge Information

Chair/Dean Information