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 Membership Committee should complete this questionnaire. There is one position available for a four-year term. The selected Committee member will serve as Committee Chair during the fourth year of their term.

The Membership Committee is responsible for recruiting new members and retaining current members, reviewing new member application documents, and making acceptance recommendations to STSA Council and members. The membership application deadline is September 15. Learn more about the function and responsibilities of the Membership 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 Membership 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. Are you interested in assisting with the 2022 abstract review process this spring?

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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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