Committee Interest Form
Full Name
Type of Practice Site
Credentials Held
Interest in Leadership Role
Do you hold any of the following certifications? (Select all that apply)
Committees of Interest
Would you be interested in serving in a leadership role for any committee?
AVAILABILITY: Please indicate your general availability for monthly committee meetings:
By submitting this form, you are expressing interest in serving on SEMP committees. Committee appointments will be made by the SEMP Board of Directors. Thank you for your interest in helping shape the future of emergency medicine pharmacy!