EMRA 45 Under 45 Nomination

Nominate Someone Great!

Complete this simple nomination form by July 15, 2019 to nominate your trailblazer (while nominations are preferred, self-nominations are also welcome). The 45 selected recipients will be recognized nationally on social media, invited to the EMRA Anniversary Reception on Saturday, October 26th, at ACEP19 in Denver, and be featured in EM Resident magazine and the EMRA website!

Criteria:

  • Emergency Medicine-trained physicians or Emergency Medicine physicians-in-training*
    • Medical students graduating in 2019 or 2020 are welcome to apply.
    • EMRA membership not required at time of selection.
    • Attendance at ACEP19 in Denver not required.
  • 45 years old or younger on or before December 31, 2019

45 Under 45 Application

Nominator

(Not required if you wish to remain anonymous)

Gender

-- Select an option --

Nominee Information

Gender

Male

Female

Prefer to self-describe

Prefer not to answer

Is the nominee 45 years old or younger on December 31, 2019?

Yes

No

Not Sure

Which of the following best represents the race of the applicant? (Not required)

-- Select an option --

Note:  If you do not know the individual's birthdate or do not have his or her CV, we will anonymously reach out for this information after the application deadline.