Emergency Medicine Certificate or Associateship Training Programs

Emergency Medicine Certificate or Associateship Training Programs - Examination Withdrawal Form
Trainee name*

TitleFirst NameLast Name
ACEM ID*
Your email*
example@example.com
Which examination are you withdrawing from?*
Which examination date are you withdrawing from?*
Which examination date are you withdrawing from?*
Which examination date are you withdrawing from?*
Reason for withdrawal*
At which hospital/site did you register to sit the exam? *
Who was your registered invigilator? *

First NameLast Name
Invigilator’s email address*
example@example.com
If you would like to register for the next exam, please use the form below:

EMC, IEMTP, AEMTP Exam Registration Form
Should be Empty:

Emergency Medicine Certificate or Associateship Training Programs - Examination Withdrawal Form