SAGES Award Recipient Reg- Advocacy

Name*
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Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Academic Title*

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Hospital Title*

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Institution*
Assistant or Contact Person Name
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An eligible recipient will attend both the SAGES Annual Meeting and the ACS Leadership & Advocacy Summit*
- I will be present to accept the ADVOCACY AWARD at the SAGES 2020 Annual Meeting, April 1, 2020 in Cleveland, OH.
- I will attend the March 28-31, 2020 ACS Advocacy & Leadership Summit at the Renaissance Washington DC Downtown Hotel
- I am unable to be present at one or both events
Registration fee for the Scientific Session portion of the SAGES Annual Meeting is waived, with the exception of hands-on course laboratories. You are welcome to bring a spouse or accompanying person with no registration fee. A Special Registration link will be sent upon acceptance that will enable you to register guests, and to register for social events and tours.
I understand that my inability to attend both the SAGES Annual Meeting and the ACS Leadership & Advocacy Summit makes me ineligible for the SAGES Advocacy Award, and that an alternate recipient will be chosen in my place.*
- Understood, I forfeit my award.
Please upload a current head-shot photograph*
Max. file size: 512 MB.
Please upload an abbreviated CV (4 pages or less)*
Max. file size: 512 MB.
Please complete this form by December 31, 2019.
Viera Ewell
viera@sages.org
310-437-0544 ext.159
SAGES, 11300 W. Olympic Blvd., Suite 600, Los Angeles, CA 90064

SAGES Award Recipient Reg- Advocacy

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