TCEP GRC Committee Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please provide the following information if you are interested in serving on our GRC committee. This is for a one-year term.

Email *

GR committee requirements: must be TCEP/ACEP member in good-standing, and available for monthly calls throughout Session (Dec - May).

GR committee benefits--
- Opportunity to establish relationship with legislators
- Invitation to advocacy training at Connect, Austin 2023
- Encouraged to attend ACEP Legislative Advocacy Conference (LAC), Washington 2023

First and Last Name *

Credentials (if applicable: MD, DO, FACEP, etc)

Membership Position: *

Physician

Resident

Medical Student

Other:

Mobile phone number (needed for GRC committee communications) *

City you live in (to determine local legislators) *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Texas College of Emergency Physicians. Report Abuse

Forms