Suggestions: What do you want to learn?

Knowledge, Practice or Performance Gaps.

This confidential form will allow you to submit suggestions that may fill an education need (knowledge, practice or performance gaps) to the CNS Education Committee. With this information, the CNS can better address the educational needs of neurosurgeons.

Question Title

* Please describe an education need you have identified in knowledge, practice, or performance.

Question Title

* I am a:

General neurosurgeon

Neurosurgical subspecialist

Resident/Fellow

(Affiliate, Associate, Medical Student)

Question Title

* My primary neurosurgical subspecialty interest is:

Tumor

Spine

Functional

Pediatrics

Peripheral nerve

Vascular

Trauma

Pain

Question Title

* I have been in practice (out of residency) for:

0 to 5 years

6 to 10 years

11 to 20 years

Over 20 years

Retired/Not practicing

Have not completed residency

Question Title

* The following OPTIONAL information is confidential.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address: