AEMUS Examination Committee Application Form

AEMUS Examination Committee Application Form

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

Last Name

First Name

Medical Credential

Professional Photo (optional)

Upload a professional photo here or email to mmaisonet@abem.org, if you choose to.

Drag and drop files here or

City/State

Email Address

Phone Number

Current Position

FPD in AEMUS Achievement*

Click here to attest that you have obtained the Focused Practice Designation in Advanced Emergency Medicine Ultrasonography. This is a requirement to be considered for this position.

Are you actively participating in ABEM Continuing Certification?

Select or enter value

Description of Current Practice in AEMUS

Please include practice setting, % of time spent in U/S, and description of U/S 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 AEMUS Examination Committee. Why do you want this opportunity? What skillset or attributes do you feel that you could contribute to this Committee?

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Send me a copy of my responses

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