EOI - Western Australia Scientific Conference Working Group 2025

EOI - Western Australia Scientific Conference Working Group 2025
The 2025 Western Australia Scientific Conference will take place at the start of May in Perth, WA as a one-day event. The working group is open to FACEMs and ACEM trainees from across Western Australia.

Please note that representatives from both the Peel and Midland Hospitals are already part of this working group (WG) as co-hosts of the 2025 Conference. They are seeking additional members from WA-based hospital staff who would like a chance to take part in the development and onsite management of this event.

If you and your colleagues would like to be considered as a WG member, please submit this form before the closing date below.

Closing date: 5:00pm on Friday 15 November 2025
Name*

First NameLast Name
ACEM ID*
Please enter your ACEM membership number.
Phone Number*
Please enter your mobile phone number.
Email*
example@example.com
ACEM Membership category*

FACEMTraineeOther
Which WA location do you work in?*
Hospital you would be representing?*
Working Group Support
Please indicate if there are additional people who would like to be involved in or support your expression of interest to be part of the working group.
Attendance

2018 ASM, Perth, Australia2019 VIC Conference2019 ASM, Hobart, Australia2020 Virtual ASM2022 Spring Symposium, Christchurch, Aotearoa New Zealand2023 Winter Symposium, New Castle, Australia2023 VIC Conference2023 ASM, Canberra, Australia2024 Aotearoa New Zealand Conference2024 Regional, Rural and Remote Conference, Darwin, Australia2024 VIC Conference (13-15 September 2024)2024 ASM, Adelaide, Australia (23-28 November 2024)
Area of interest

Developing the programOrganising social functionsOrganising workshops
Will you be able to attend the one-day Conference in-person? (Date will be between 1 May - 17 May 2025)

YesNoUnsure
Statement of Suitability

Please include a short statement of suitability/intent indicating knowledge, skills and experience relevant to the Working Group for which you are applying.0/500
ACEM Core Values Module

The ACEM Core Values of respect, integrity, collaboration, and equity define the organisations guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand.

From the start of 2022, all future appointees to ACEM roles and entities are required to have completed the ACEM Core Values Module; the close of the applicable expression of interest/nomination process and outline how they demonstrate the Core Values within their workplace.
Have you completed the ACEM Core Values Module?*

YesNo
Demonstrate core values*
Please describe how you demonstrate all four ACEM Core Values within your workplace. In respect to retired Fellows please describe how you demonstrate the ACEM Core Values in your dealings with others.
Conflicts of interest*
Please identify any actual or perceived conflicts of interest.
I acknowledge that the information that I provide on this form will be provided to ACEM staff.*

I acknowledge
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EOI - Western Australia Scientific Conference Working Group 2025

ACEM Core Values Module