Medical Student Council Application Form

EMRA Medical Student Council Application Form

 

Contact Information
(Questions notated with a * are required.)

* Full Name:

 

* Address:

 

* City:

 

* State:

 

 

* Zip Code:

 

Country:

 

Cell Phone:

 

Home Phone:

 

* Email Address:

 

Are you an EMRA Member?

 

Membership #
(ex: A111111)

 
Medical School:


Graduation Year:


Are you available to attend the
CORD Annual Meeting in April
and ACEP's Scientific Assembly
in September (to the best of your
knowledge)?



  

Position you are applying for:


Will you serve in a different capacity
if you are not chosen for the position
to which you are applying:
 
  

What do you hope to bring to EMRA and to the MSGC/MSC during your term of appointment?:


 

Below please upload the following documents: Letter of Intent, CV and a Letter of Support (recommended but not required) from an EM faculty member, Resident, Medical School Dean or Student Affairs Official

 

NOTE: Hit 'Submit' on the online form before uploading files. Also, files will need to be uploaded one-at-a-time.

Upload your document

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