MSS Fall Conference

Evaluation Form

AMERICAN COLLEGE OF SURGEONS

Division of Education

Minnesota Surgical Society

American College of Surgeons Chapter

2023 Fall Conference

September 29-30, 2023

Rochester, MN

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* 1. Name

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* 2. Credentials

MD, FACS

DO, FACS

Other (please specify)

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* 3. Email Address

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* 4. Are you a member of the American College of Surgeons?

YES

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* 5. ACS Membership ID (credits will not post to your ACS MyCME webpage if ID not provided)

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* 6. State(s) you are licensed?

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* 7. Choose One

Active Member

Associate Member

Resident

Medical Student

Research Trainee

Retired

Non-Member

MSS Fall Conference

Evaluation Form

Question Title

* 1. Name

Question Title

* 2. Credentials

Question Title

* 3. Email Address

Question Title

* 4. Are you a member of the American College of Surgeons?

Question Title

* 5. ACS Membership ID (credits will not post to your ACS MyCME webpage if ID not provided)

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* 6. State(s) you are licensed?

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* 7. Choose One

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* 8. Number of years in practice (optional)

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* 9. Specialty (optional)