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The Association for Surgical Education

The Association for Surgical Education

Impacting Surgical Education Globally

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ASE Moderator Interest Form

Please complete the form below to let us know you are interested in moderating a session at the ASE Annual Meeting! Please note that completion of this form does not automatically mean that you will be invited to moderate; we will follow up with you in the fall with formal next steps. Registration to the ASE Annual Meeting and in person attendance is required to participate. 

Keep in mind that the more date/time options you select for your availability below, the more likely you are to be selected to moderate! Deadline to submit your name is Friday, January 10, 2025. 

If you have any questions or concerns, please email Lorena Gonzalez at [email protected]

 

ASE Moderator Interest Form

Name(Required)
Please Select One:(Required)
Are you planning on attending ASE 2025 in Seattle next May?(Required)
*Moderator sessions are in person only
Are you a member of the ASE?(Required)
*ASE membership is required to participate
What ASE committee are you currently a member of? (Check all that apply)(Required)
Please select when you are available to moderate (Check all that apply)(Required)
Area of Expertise (Check all that apply)(Required)

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11300 W. Olympic Blvd
Suite 600
Los Angeles, CA 90064 USA
(310) 215-1226
[email protected]

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