The New York American College of Emergency Physicians exists to support quality emergency medical care and to promote the interest of emergency physicians.

Send Request


Speaker Directory Inclusion Registration

(*) Required | New York ACEP Membership Required for Inclusion
First Name(*)
Please type your first name.

Last Name(*)
Please type your last name.

Degrees/Credentials Note: Hold the Ctrl key for multiple selections
Invalid Input

Other Degrees/Credentials
Please type your Other Credentials.

Job Title
Please type your job title.

Institution
Please type your Institution.

Street Address
Please type your street address.

City(*)
Please type your city.

State(*)
Please type your state.

Zipcode(*)
Please type your zip code.

Email Address(*)
Please type your correct email address.

Honoraria Required
Invalid Input

Travel Expense Required
Invalid Input

What regions are you willing to travel to speak? (select all that apply)
Note: Hold the Ctrl key for multiple selections(*)
map
Invalid Input

Area(s) of Interest
Speaking Topics Note: Hold the Ctrl key for multiple selections(*)

Invalid Input

Other (please specify)
Please select option.

Biography
Please type your biography.

Photo(*)
Photo must 500kb or below.

.pdf (Files)
Please upload only PDF File.

.pptx (Files)
Please upload only PPT File.

.mp4
Invalid Input

.mov
Invalid Input