While you’re in Cleveland for SAGES 2024, please consider sharing a little of your time to help the society in exchange for a $50 Amazon gift card. We are reaching out to surgeons, fellows and residents to engage in a 45 minute, conversation-based interview centered on your experience trying out our NEW online educational modules. Interviews will take place on-site at the Huntington Convention Center on Wednesday, April 17 – Friday, April 19, 2024. Space is limited and each participant will receive their Amazon gift card after the interview is completed. If you’re interested in participating, please fill out and submit the form below. Thank you!Name(Required) First Last Institution(Required)Location(Required) City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Preferred Email(Required) Cell Phone Number(Required)Please indicate if you would like to receive texts in relation to SAGES Education Module Interview.(Required) Yes No Are you a SAGES Member(Required) Yes No Application Submitted Are you in surgical practice?(Required) Yes Still in training Retired No / Not applicable (Advance Practice Provider or other non-physician) Other What type of trainee are you?(Required) Fellow – Surgical Fellowship Resident – General Surgery Other Year completed (or will complete) residency:(Required)Year completed (or will complete) fellowship:(Required)If you did not do a fellowship or are not planning on doing a fellowship, please enter n/a above. Specialty Type (select all that apply)(Required) Acute Care Surgery Endocrine General/ MIS (includes Foregut, Flexible Endoscopy, Hernia) HPB Pediatric Surgical Oncology Thoracic Transplant Trauma Still in training / undecided Other Please define other from choice above.(Required)Practice Type(Required) Community: Private-Solo Community: Private-Group Community: Hospital Employed Military service/Veterans Affairs Academic Other Is your practice or institution affiliated with a surgical training program?(Required) Yes No Do you participate in the surgical training prgram?(Required) Yes, as a Fellowship Program Director or Associate Program Director Yes, as a Residency Program Director or Associate Program Director Yes, as Faculty No