Committee Application Form

Committee Application Form

Please complete the form below to submit your application for an ACOEP Committee
ACOEP members are a phenomenal resource! As a member, you are invited to participate in ACOEP’s wide-variety of committees! No matter your interest, ACOEP’s active committees are your avenue to affect lasting change in the medical community. Take a moment to see which committee might suit your needs and complete the form below to submit an application to participate.

For more information and a description of each committee please visit the ACOEP website.
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Please select the committee(s) below that you would like to participate in (up to 3)*

Academic AffairsBylaws/GovernanceContinuing Medical Education (CME)Emergency Medical Services (EMS)FinanceMembershipNew Physicians In Practice (NPIP)Nominations, Awards and Fellowship (NAF)Physician WellnessPractice AdvocacyResearchResident Student Advisory CommitteeWomen in EM
In the upload space below please submit a brief letter of interest for each committee(s) that you would like to participate in and a copy of your most recent CV.
Upload your Letter(s) of Interest and CV below*

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