GCEP Committee Interest Form

Years (Term):
Name:
Address:
City:
State:
Phone:
Email:
Year Joined GCEP:


I would like to serve on the following GCEP Committee(s):
(Please indicate order of preference by putting a number 1-6 in the box next to the committee name, 1 being your first choice, etc.)

Bylaws
Education and Research
Electronic Media
Membership
Finance
Governmental Affairs


What skills or qualities would you bring to this committee that should cause you to be selected:


I am currently serving or have previously served on the following ACEP Committees (national):

I am currently serving or have previously served on the following GCEP Committees (state):

Please email your CV to Tara Morrison at tara@theassociationcompany.com.

Direct all questions to Tara Morrison at:

Georgia College of Emergency Physicians
Suite 101
6134 Poplar Bluff Circle
Norcross, GA 30092

Phone: 770-613-0932 (Office)
           404-966-8628 (Cell)

Email: tara@theassociationcompany.com