AO Spine NA Fellowship Survey - August 2022

Dear AO Spine NA Fellows,

On behalf of the AO Spine NA Fellowship Committee, welcome! Your institution receives funding from AO Spine NA and as such, you are an AO Spine NA Fellow. Throughout the year, we'll send you information about courses, award opportunities, and other offerings. Additionally, you will be pre-registered for the AO Spine NA Webinar series. Look out for the calendar invites.

Please fill out your details below and contact Jonathan O'Neal at oneal.jonathan@aona.org with any questions.

Question Title

* 1. Please complete the following (we want to ensure we can contact you, even after your current fellowship)

Your Name

Your Institution

Preferred Email Address

Preferred Phone Number (only used if necessary)

Question Title

* 2. Do we have your permission to share your preferred email address with our sponsors upon request? (your phone number entered above will not be shared.)

Yes

Yes, but please share a different email address (enter the address here)

Question Title

* 3. What are the start and end dates of your current fellowship?

Start Date

Date

End Date

Date

Question Title

* 4. In the event that we need to mail something to you, what is your preferred mailing address? (will not be shared outside of AO North America Staff)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country