The Southern Thoracic Surgical Association (STSA) is currently accepting self-nominations from Active STSA Members for vacant Committee positions. The deadline to nominate yourself for a Committee position is December 9, 2021; terms will begin on January 1, 2022.

STSA members interested in joining the Program Committee should complete this questionnaire. There are two positions available for a three-year term. The selected Committee members will serve as Committee Co-Chairs during the third year of their terms.

The Program Committee is responsible for planning the scientific educational content of the STSA Annual Meeting. Committee members review abstract submissions in late-April through early-May. A Committee meeting takes place each spring to finalize the Annual Meeting program. Learn more about the function and responsibilities of the Program Committee at https://stsa.org/bylaws/.

If you have any questions about the STSA governance structure and the self-nomination process, please contact STSA at stsa@stsa.org or 312-202.5892.

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* 1. First Name:

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* 2. Middle Name:

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* 3. Last Name:

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* 4. Hospital/Institution:

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* 5. City:

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* 6. State:

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* 7. Country:

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* 8. E-mail:

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* 9. Office Phone Number:

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* 10. Cell Phone Number:

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* 11. Assistant's Name (enter NA if not applicable)

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* 12. Assistant's Email (enter NA if not applicable)

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* 13. Please indicate your primary area of expertise and interest (select all that apply):

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* 14. Brief Biography: Please provide a brief description of your background and relationship with STSA. Please limit your response to 100 words or less.

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* 15. Please describe your interest in joining the STSA Program Committee. You may include any specific qualifications that make you particularly suited to participating on this Committee. Please limit your response to 100 words or less.

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* 16. The STSA Program Committee annually seeks to identify surgeon members to assist in reviewing Annual Meeting abstract submissions. If you are not selected to this Committee in 2022, would you still be interested in assisting with the abstract review process?

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* 17. By submitting this questionnaire, I agree to complete and return a disclosure form to STSA in the event that I am named to an STSA Committee. Additionally, I understand that disclosure information will be collected and filed with STSA annually throughout the duration of my Committee term. My annual disclosure information may be made public and shared with STSA members and leaders.

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* 18. By submitting this questionnaire, I agree to carry out the duties of a prospective Committee appointment for the duration of the term to the best of my abilities.

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* 19. By submitting this questionnaire, I agree to comply with the STSA Code of Ethics, which mandates the highest level of professional deportment in all interpersonal interactions.

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