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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
1
2
3
N/A
Education Committee
1
2
3
N/A
Accommodations Committee
1
2
3
N/A
Membership Committee
1
2
3
N/A
Nominating Committee
1
2
3
N/A
Research Committee
1
2
3
N/A
LGBTQIA+ Committee
1
2
3
N/A
Mentorship/Student and Trainee Committee
1
2
3
N/A
Operations Committee
1
2
3
N/A
Thank you for completing the 2023-2024 ADIEM Committee Interest Form.
Please click on done to submit your selections.