Name(Required) First Last Degree(Required)Email(Required) Title(Required)Institution(Required)Select one of the following(Required) Surgical Resident Simulation Fellow Fellow (non Simulation) Junior Faculty (within 5 years of training) Senior Faculty (greater than 5 years of training) ASE Member(Required) Yes No Brief Biosketch(Required)Photo (Optional)Accepted file types: jpg, png, Max. file size: 512 MB.Certificate Confirmation(Required) I confirm that I must participate in at minimum 14 sessions and complete the associated assessments and quizzes to receive a certificate. Attendance will be confirmed via the Zoom meeting chat, as well as the completion of the post session assessment and quiz. Registration Fee Confirmation(Required) I confirm that if my registration is accepted, I agree to pay the registration fee of $800 prior to the program start.
