Nov-Dec 2011 Newsletter.pdf - The Society for Academic ...

Membership Application
Name: Title: Email:
Institution address:
City: State: Zip: Country:
Home address:
City: State: Zip: Country:
Preferred mailing address: Office Home Sex: M F Birth date:
Office phone: ( ) Home phone: ( ) Fax: ( )
Active - $560.00 Individuals with advanced degree university
appointment actively involved in EM teaching or research.
Associate - $250.00 Open to those with interest in EM
Young Physician Year One - $335.00 First year following
residency graduation.
Young Physician Year Two - $460.00 Second year following
residency graduation.
Resident/Fellow - $165.00 Open to residents/fellows interested
in EM. Graduation date:
Check Membership Category
International - email membership for pricing
*Active/Associate/YP1 or YP2 Academy - $100.00 ea.
AEUS AWAEM CDEM Simulation
GEMA Geriatrics
*Medical Student/Resident/Fellow Academy - $50.00 ea.
AEUS CDEM Simulation Geriatrics
*GEMA Medical Student - $25.00 ea.
*AWAEM Resident/Fellow/Medical Student - FREE
Medical Student - $140.00 Open to medical students interested
in EM. Graduation date:
*GEMA Resident/Fellow - FREE
*must be a current SAEM member to join an academy
Interest Groups: Society members are invited to join any of the dedicated Interest Groups listed below.
Each membership category includes ONE Interest Group free of charge. Additional Interest Groups can be added for $25.00
Academic Informatics
Airway
CPR/Ischemia/Reperfusion
Clinical Directors
Disaster Medicine
Diversity
ED Crowding
Educational Research
EMS
Ethics
Evidence-Based Medicine
Health Services & Outcomes
Neurologic Emergencies
Palliative Medicine
Patient Safety
Pediatric EM
Public Health
Observational Medicine
Quality Medical Mgt
Research Directors
Sports Medicine
Toxicology
Trauma
Triage
Uniformed Services
Wilderness Medicine
Method of Payment Enclosed Check Credit Card (Visa or MC) Total:
Name as it appears on credit card
Card Number:
Expiration Date: Billing Zip Code: Signature:
SAEM, 2340 S. River Rd, Suite 200 Des Plaines, IL 60018. email: membership@saem.org You may also join at member.saem.org
Rev. Date 10/26/2011