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AAEMRSA


AAEM Resident & Student Association Nomination Form

Nominations for these positions will be accepted until January 1, 2019 at 11:59pm CT and should be submitted to the AAEM/RSA office.

*** Please complete the following and submit to AAEM/RSA by January 1, 2019 ***

AAEM/RSA Board of Directors
A total of three officers (president, vice president and secretary-treasurer), and six at-large members of the board of directors will be elected by the resident membership for the 2019-2020 academic year.

I would like to nominate the following individual for the position of:
  President
  Vice President
  Secretary-Treasurer
  At-Large Board Member



AAEM/RSA Medical Student Council
A total of two officers (president and vice president), four regional representatives, and one international ex-officio member for the AAEM/RSA medical student council will be elected by the medical student membership for the 2019-2020 academic year.

I would like to nominate the following individual for the position of:
  President (serves a dual role as the student representative to the AAEM/RSA board of directors)
  Vice President
  Regional Representative (West)
CA, OR, WA, NV, AZ, NM, UT, CO, ID, MT, WY, AL, TX, ND, SD, NE and HI
  Regional Representative (South)
KY, WV, VA, TN, NC, SC, GA, AL, MS, FL and P.R.
  Regional Representative (Northeast)
NY, PA, NJ, DE, MD, CT, RI, MA, NH, VT, ME and D.C.
  Regional Representative (Midwest)
KS, OK, MN, IA, MO, AR, LA, WI, IL, IN, OH and MI
  International Ex-Officio Member



Nominee:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Your Name (if not nominee):
Nominee Medical School/Residency Program:
Email (if not nominee):

Nomination Statement
Fill out this portion if you are nominating someone else (300 words maximum):

Candidate Platform Statement
Fill out this portion if you are nominating yourself (300 words maximum):


Attach nominee's CV here (1 MB limit):

Attach nominee's photo here (optional; 3 MB limit):