ABS EPA Project - Grand Rounds Presentation Request Survey

1.Please enter the contact information of the person who will be responsible for coordinating a speaker to present to your program.(Required.)

Name

Program/Institution

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Please identify the specialty area for which you are seeking a Grand Rounds presentation.(Required.)

General Surgery

Vascular Surgery

3.Would you prefer an in-person presentation or a virtual presentation?(Required.)

In-person

Virtual

No preference / flexible on format based on speaker availability

My program would prefer a pre-recorded Grand Rounds video

4.Do you plan to offer CME for this Grand Rounds-style event?
If yes, the ABS is able to provide questions and objectives for participants.(Required.)

Yes

No

Undecided