Chief Residents Survey Application Chief Resident Application Survey for AOAO Meeting Funding Question Title * 1. Please provide your contact information below, include your first and last name, mailing address, email address and phone number. This information is required to notify you of acceptance and process your reimbursement. First and Last Name: Mailing Address: Phone Number: OK Question Title * 2. Name of your residency training program. OK Question Title * 3. Name of your Program Director. OK Question Title * 4. How will you attend the Annual Spring Meeting, April 15-17, 2021 in Salt Lake City, UT? In Person Virtually OK Question Title * 5. Do you plan to continue your training in a fellowship? yes no OK Question Title * 6. If yes, please let us know where you will train so we may extend your free membership. Fellowship program name: Training complete month/year: Specialty: OK Question Title * 7. If no, please give us your new practice information so we can make sure you receive the discounted member rate for your first year in practice. OK Question Title * 8. The Academy would like to add subject matter to future meetings of interest to our Candidate/Resident members. Please check below which topics are of interest to you. Board Review Course Contract Negotiation Billing/Coding Lectures Student Loan Repayment Other (please specify) OK DONE
