Emergency Medicine Foundations Learner Registration Form
Foundations Learners,

Your residency program will be incorporating Emergency Medicine Foundations course content to your conference curriculum this year. We appreciate your completion of the following registration as an individual learner at your site. The information provided will be used for course analysis and to contact you with any important updates or assignments over the course of the year. Your contact information will not be shared with any other parties.

Thanks,

Kristen Grabow Moore, MD, MEd
National Course Director
Emergency Medicine Foundations
www.emergencymedicinefoundations.com

What is your last name?
Your answer
What is your first name?
Your answer
What is your preferred e-mail address for Emergency Medicine Foundations communication?
Your answer
What is the name of your residency program?
Your answer
What type of learner are you?
In general, which of the following resources do you prefer using for independent study of Emergency Medicine? (select all that apply)
Required
Why do your prefer these resources?
Your answer
In general, how much time are you planning to spend on independent study in Emergency Medicine each week?
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