2025 Forms | Maryland Chapter of ACEP

2025 Chapter Board of Director Open Positions Submission Form

The Maryland ACEP Chapter seeks motivated dedicated emergency physicians for open Chapter Board positions. Join our mission to shape the future of emergency medicine, influence policy, and make a lasting impact! As a member, you can contribute to the mission of our chapter.

Personal Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

This number will not be shared with anyone outside of the Maryland ACEP Chapter Board or Chapter Executive Director.

Preferred Contact Method(Required)

Are you a member of the Maryland ACEP Chapter in good standing?(Required)

Hospital Affiliation

Name of Hospital(Required)

Address of Hospital(Required)

City State / Province / Region

What is your current role?(Required)

Position of Interest

Which open position are you interested in running for?(Required)

Terms for these open positions are two years and three consecutive two-year terms.

Councillor

Alternate Councillor

Please summarize in a max of 250 words brief statement of interest outlining your motivation and qualifications.(Required)

Do you agree to attend the 2025 & 2026 Council Meeting?(Required)

2025 Council Meeting in Salt Lake City, Utah and 2026 Council Meeting in Chicago, Illinois (https://www.acep.org/how-we-serve/council)

Do you agree attend the 2025 Pre-Council Summit that is held in-person at MedChi in Annapolis?(Required)

This event is hosted by the Maryland ACEP Chapter and is held every year prior to ACEP's Council Meeting (https://www.mdacep.org/chapter-events/)

Headshot(Required)

Please upload a headshot

Accepted file types: jpg, jpeg, gif, Max. file size: 50 MB.

Curriculum Vitae(Required)

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Questions, Comments, and Concerns

Please use this section to provide any additional information relevant to your interest in the open Chapter Board positions (if necessary).

2025 Chapter Committee Submission Form

This form should be used if you are interested in becoming a member of a Maryland ACEP Chapter Committee. The Committees are Education, EMS, Membership, Pediatric EM, EMPACt (PAC), Practice Management, Legislative/Public Policy, and Nominations Committees. Read more about each committee (https://www.mdacep.org/committees/)

Personal Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

This number will not be shared with anyone outside of the Maryland ACEP Chapter Board or Chapter Executive Director.

Preferred Contact Method(Required)

Which Chapter Committee are you interested in?(Required)

Multiple can be chosen.

Why does this/do these Chapter Committees interest you?(Required)

Hospital Affiliation

Name of Hospital(Required)

Address of Hospital(Required)

City State / Province / Region

What is your current role?(Required)

Headshot(Required)

Please upload a headshot

Accepted file types: jpg, jpeg, gif, Max. file size: 50 MB.

Curriculum Vitae(Required)

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Questions, Comments, and Concerns

Please use this section to provide any additional information relevant to your interest in a Chapter Committee (if necessary).

2025 Chapter Resident Competition Submission Form

We encourage all Resident Chapter Members to join us for our annual Resident Competition, an exciting opportunity to highlight your exceptional talent and expertise in Emergency Medicine. This is your chance to shine and be recognized among your peers!

Personal Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

This number will not be shared with anyone outside of the Maryland ACEP Chapter Board or Chapter Executive Director.

Preferred Contact Method(Required)

Are you a Resident member of the Maryland ACEP Chapter in good standing?(Required)

Residency Program Affiliation

Name of Residency Program(Required)

Residency Program Address(Required)

City State / Province / Region

Presentation Information

What is the title of your presentation?(Required)

Please submit a 250-word abstract outlining the presentation topic.(Required)

Please submit your presentation objectives(Required)

Headshot(Required)

Please upload a headshot

Accepted file types: jpg, jpeg, gif, Max. file size: 50 MB.

Curriculum Vitae(Required)

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Questions, Comments, and Concerns

Please use this section to provide any additional information relevant to your interest in the annual Resident Competition (if necessary).

2025 Chapter Awards Submission Form

The Maryland ACEP Chapter is calling for nominations to honor outstanding individuals who have made impactful contributions to the field of emergency medicine. This is your opportunity to shine a spotlight on colleagues who exemplify excellence, leadership, and unwavering dedication to our specialty. Let’s recognize those who inspire us and elevate the standard of care in our community! Read Award Categories & Criteria

Nominator Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Preferred Contact Method(Required)

Are you a member of the Maryland ACEP Chapter in good standing?(Required)

Hospital Affiliation

Name of Hospital(Required)

Address of Hospital(Required)

City State / Province / Region

Are you nominating a colleague or submitting a self-nomination for a Chapter Award?(Required)

Self-nominations are permitted.

For which Chapter Award are you nominating a colleague or self-nominating?(Required)

Self-nominations are permitted.

Nominee Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

This number will not be shared with anyone outside of the Maryland ACEP Chapter Board or Chapter Executive Director.

Is the nominee a member of the Maryland ACEP Chapter in good standing?(Required)

Please submit a brief narrative (500 words or less) describing the nominee's achievements, contributions, and impact on emergency medicine.(Required)

Nominee Headshot(Required)

Please upload a headshot

Accepted file types: jpg, jpeg, gif, Max. file size: 50 MB.

Questions, Comments, and Concerns

Please use this section to provide any additional information relevant to your interest in the Chapter Award Nomination process (if necessary).

2025 Chapter Medical Student Volunteer Opportunity Submission Form

Volunteer at Our Upcoming Medical Education Conference! Join us as a volunteer at our prestigious medical education conference, taking place on Thursday, March 27, 2025, 8:00 AM-5:00 PM; Event Address: 621 W Lombard Street, Baltimore, Maryland 21201; Volunteer today - this is a unique opportunity!

Personal Information

Name(Required)

First Middle Last Credentials

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

This number will not be shared with anyone outside of the Maryland ACEP Chapter Board or Chapter Executive Director.

Preferred Contact Method(Required)

Are you a member of the Maryland ACEP Chapter in good standing?(Required)

Hospital Affiliation

Which hospital are you affiliated with?(Required)

Do you have any Dietary Restrictions?(Required)

Headshot(Required)

Please upload a headshot

Accepted file types: jpg, jpeg, gif, Max. file size: 50 MB.

Curriculum Vitae(Required)

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Questions, Comments & Concerns

Please use this section to provide any additional information relevant to your interest volunteering during the 2025 Educational Conference & Annual Meeting (if necessary).