CanSAGE ECEP - EndoSURG Québec City September 30 Question Title * 1. Full Name Question Title * 2. Pronouns (optional) Question Title * 3. Email Question Title * 4. Address Question Title * 5. Phone Number Question Title * 6. What is the primary language used in your practice? English French Other (please specify) Question Title * 7. When did you finish your residency program? <2 years 2-5 years 5-10 years >10 years Question Title * 8. Have you completed a fellowship in Minimally Invasive Surgery? Yes No Question Title * 9. At which hospital do you usually perform laparoscopic surgery? Question Title * 10. What describes your practice setting? Please select all that apply. Academic Community Urban Suburban Rural Remote Question Title * 11. Do you perform Laparoscopic Gynecologic Surgery on a regular basis and are interested in improving your skills in excision of superficial endometriosis? Yes No Question Title * 12. Will you register and attend the CanSAGE Conference taking place in Québec City October 1-3, 2026? Yes No Question Title * 13. Are you a first‑time CanSAGE conference participant in 2026? Yes No Question Title * 14. Will you be able to attend the entire course starting the morning of September 30, 2026? Yes No Question Title * 15. Are you able to commit to a 6‑month mentorship period following the conference, including: (1) Personalized pairing with a minimally invasive surgery (MIS) fellowship‑trained mentor (matched by CanSAGE), and (2) Submission of surgical video footage for mentor review, with up to two one‑hour feedback sessions over six months. Yes No Question Title * 16. Do you have the ability to record surgical footage in the OR for review in the future? This is usually performed with a recording device directly connected to the laparoscopic tower, exported to a USB drive. Taking a video recording with a handheld phone would not be acceptable as the footage is insufficient Yes No Done