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:




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


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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