SECTION ON EMERGENCY MEDICINE
SOEM Subcommittee Application Form

Those interested in applying should submit an application via regular mail or by e-mail to Joan E. Shook, MD, MBA
Chairperson of the Section on Emergency Medicine.

Name _____________________________________________________________________

Institution ___________________________________________________________________

Address ____________________________________________________________________

__________________________________________________________________________

Phone Number_______________________________________________________________

Member of AAP since ___________________________________

AAP Member Number __________________________________

E-mail address _________________________________________

Please circle the Subcommittee you wish to join:

Please Return Completed Form To:

Joan E. Shook, MD, MBA
Department of Pediatrics/Emergency Medicine
Baylor College of Medicine
One Baylor Plaza
Houston, TX 77030-2303
E-mail: jeshook@texaschildrenshospital.org

Index - Section on Emergency Medicine

Updated 2/05