PedsEM Subboard Application Form

PedsEM Subboard Application Form

Applicants will be asked to update their demographic information in the ABEM portal.

Last Name

First Name

City, State

Email Address

Phone Number

Current Position

Continuing Certification*

Click here to attest that you are participating Pediatric Emergency Medicine Continuing Certification.

Participate in Continuing Certification:

Are you actively participating in ABEM Continuing Certification?

Select or enter value

Description of Current Practice in Pediatric Emergency Medicine

(Please include practice setting, percentage of time spent in Pediatric Emergency Medicine, and a description of your Pediatric Emergency Medicine clinical work.)

ABEM Volunteer Experience (if applicable)

Item Writer

Item Writer Dates

Oral Examiner

Oral Examiner Dates

Other ABEM Volunteer Experiences

Other Volunteer Appointments (please specify)

Statement of Interest

Please provide a statement of interest in serving on the Pediatric Emergency Medicine Subboard. Why do you want this opportunity?

Please upload a 1-2 page biography.

Drag and drop files here or

Headshot

Please send Marijo Maisonet a recent photo - mmaisonet@abem.org.

Send me a copy of my responses

Privacy Notice|Report Abuse