Home
AAEM/RSA
AAEMRSA

Residency Visit Application

Dear Residency Program Director:

Please provide the following information to schedule a speaker for your EM residents.

Name of Program:
Mailing Address 1:
Mailing Address 2:
City:
State:
Zip:
Number of EM Residents:
Primary Contact Person:
Phone:
Email:
Secondary Contact Person:
Phone:
Email:

Based upon your available dates and requested topic(s), a national leader of AAEM will be scheduled to provide a clinical or practice management presentation to your residents and faculty.

Available Dates (6-8 weeks lead time is preferred)

Choice 1:
Choice 2:
Choice 3:
Choice 4:

Requested Speakers

Choice 1:
Choice 2:
Choice 3:

Every effort will be made to coordinate a date with your desired speaker, but we cannot guarantee their availability on the date(s) chosen by your program.

An AAEM overview talk will be provided. In addition, clinical/administrative talks can be included. Please list the topic(s) of interest below.

Requested Topics

Choice 1:
Choice 2:
Choice 3: