EMBRS Wait List Form

Request for EMBRS Registration Waiting List

Please complete this form to be placed on the waiting list for the EMF/ACEP Emergency Medicine Basic Research Skills (EMBRS) Workshop.

You will receive an e-mail confirming your name was placed on the list. When a space is available, we will notify you and request the registration fee. Once the registration fee is received, you will receive confirmation that you are registered for the class.  

For information about the ACEP/CORD Teaching Fellowship or ACEP/CORD Resident's Teaching Fellowship, please email academicaffairs@acep.org.

  

* Full Name:
Member ID:
* Address:
* City:
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*Institution:
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Other:
* Military
      



 

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