2023-2024 ADIEM Committee Interest Form

1.Full Name(Required.)
2.Institution Name(Required.)
3.Professional/Institution Email Address(Required.)
4.Personal Email Address
(This is used for accuracy/tracking in the SAEM database)
5.Please select up to 3 committees you would like to join, with 1 being your top choice and 3 your last choice.(Required.)
1
2
3
N/A
Social Media Committee 
Education Committee 
Accommodations Committee 
Membership Committee 
Nominating Committee 
Research Committee 
LGBTQIA+ Committee
Mentorship/Student and Trainee Committee 
Operations Committee
Thank you for completing the 2023-2024 ADIEM Committee Interest Form. 

Please click on done to submit your selections.