Mock Candidates Required for OSCE Station Rehearsal

Expression of Interest

Please fill out this form to express your interest in the above role.
Name*

First NameLast Name
ACEM ID*
Phone Number*
Your Email*
Are you a current ACEM Fellow?*

YesNo
You must be an ACEM Fellow to participate in this event.
Date Fellowship obtained*

DayMonthYear
Date
Have you participated as a mock candidate previously?*

YesNo
Which days are you available?*

Tuesday 18 MarchWednesday 19 MarchThursday 20 MarchFriday 21 March
What is the maximum number of days you would be interested in attending as a mock candidate?*
Any additional comments?
Should be Empty:

Expression of Interest