AAEM Resident and Student Association

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:
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: