2024 FAEMSMD Membership - Through June 30, 2025

Florida Association of EMS Medical Directors
400 N. Wymore Road.
Winter Park, FL 32789
Email: mhernandez@emlrc.org
Website: www.faemsmd.org
Membership Application

Join/Renew Now for FAEMSMD benefits through June 30, 2025.
About:

The Florida Association of EMS Medical Directors is dedicated to promoting the practice of EMS medical direction in Florida. It serves as a resource for local EMS medical directors and agencies, providing the latest news and information in EMS medical direction. FAEMSMD serves as a forum for exchange of ideas on best serving the people of Florida through the most advanced and highest quality EMS and pre-hospital care. FAEMSMD is also an advocate on behalf of EMS medical directors to policy makers in the Florida Legislature and state agencies.

FAEMSMD meets quarterly at the State EMS meetings held by the Department of Health, Bureau of EMS. FAEMSMD is a member of the State EMS Advisory Council as well as the Medical Director Advisory Panel, which advises the State EMS Medical Director on statewide EMS issues.

Benefits of Membership:
- Legislative and regulatory monitoring and participation
- Representation on National workgroups and committees
- Advisor to the Florida Department of Health through our State EMS Medical Director
- Quarterly meetings covering current topics that impact EMS systems on a state and national level
- Quarterly membership enewsletter
- Online membership platform-Provide scholarship and other financial support to statewide education programs and offerings
1. Member Information
Name*

First NameLast Name
Designation/License (MD, DO, FACEP, EMT-P, etc.)*
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Medical Specialty*
2. EMS System Information
Name of EMS System*
Address of EMS System*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
City/County Served*
Co-Directors*
Other EMS Systems Serviced*
3. Membership Categories & Dues
Note: The annual membership year is changing from January - December (in alignment with the calendar year) to July 1 - June 30 (in alignment with the academic year) as voted by our members.

Each EMS provider system is allowed one Active (voting) membership and an unlimited number of Associate memberships.
4. Auto Renewal Opt-in/Out
Auto Renewal: To streamline the renewal process, FAEMSMD memberships are eligible for auto-renewal but members must "opt-in". Members must complete the following attestation to indicate approval of auto-renewal.

Note: Future renewals will reflect a 12-month membership period and incur 100% of current dues assessments in each respective category ($325, $125, $0).
Auto Renewal Opt-in/Out - Please Choose One.*

Opt-in: I would like to auto renew my FAEMSMD membership at the end of the current membership period (June 30th) for the next 12-month membership cycle. I understand that my provided payment method will be charged according to my memebrship category for a 12-month period ($325, $125, or $0).Opt-out: I do not want to auto renew my FAEMSMD membership at the end of the current membership period (June 30th). I understand that this may result in a lapse in member benefits.
5. Payment Options
Credit cards: Credit cards payments will be accepted online only. Please use the membership link provided to join/renew and submit payment by credit card.

Checks: Checks will be accepted when accompanied by a completed hard-copy membership application.

My Products*

Active Membership (1 year, July 1, 2024 - June 30, 2025)Open to physicians responsible for the medical direction of a pre-hospital care system. Each member is entitled to one vote when present at quarterly meetings.

$325.00 Quantity

Associate Membership (1 year, July 1, 2024 - June 30, 2025)Open to individuals or institutional/corporate entities associated with pre-hospital medical care and medical directors earning less than $20,000 annually for their medical direction contract. Associate members may serve on various committees and participate in the affairs of FAEMSMD but may not serve as officers and do not have voting powers (unless delegated by an active member, as outlined in the bylaws).

$125.00 Quantity

RETIRED Associate Membership (1 year, July 1, 2024 - June 30, 2025)Open to retired medical directors. Retired associate members may serve on various committees and participate in the affairs of FAEMSMD but may not serve as officers and do not have voting powers (unless delegated by an active member, as outlined in the bylaws).

$125.00 Quantity

EMS Fellow/Resident Membership (1 year, July 1, 2024 - June 30, 2025)Open to emergency medicine residents and EMS fellows currently enrolled in an ACGME-accredited training program in Florida. Residents/Fellows must apply for membership with review/approval by the executive committee. Resident/Fellow members do not have voting powers. Resident/Fellow members will be asked to provide at least (1) review/summary of an evidence-based medicine article related to EMS OR (1) CME presentation at one FAEMSMD meeting annually.

$ Free Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Membership Application

1. Member Information

2. EMS System Information

3. Membership Categories & Dues

4. Auto Renewal Opt-in/Out

5. Payment Options