Add - AGA Online Membership Application

Personal Information

Prefix:

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First Name:

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Middle Name:

Last Name:

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Suffix:

Job Title:

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Organization:

Sex:Required

Race:Required

Address

Country:

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Street Address:

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City:

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State:

Zip/Postal Code:

Phone:

Email:

Please identify your level of experience:

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Please identify your primary areas of focus (check all that apply):Required

Basic

Clinical

Adult

Pediatric

Liver

Luminal GI

Have you previously attended an Academic Skills Workshop?Past workshop attendees are ineligible to attend future Academic Skills Workshops.

YesNo

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Please provide a a short statement (no more than 500 words) describing your research interests and how the workshop will advance your career goals:

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Support documents

Upload a current CV or Biosketch-Please upload as an Adobe PDF document.

Upload CV

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Upload your research proposal-Research proposal: Background, specific aims, methods. The proposal should be no more than 2 pages, excluding references. Please upload as an Adobe PDF document.

Upload Research Proposal

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Upload a letter of recommendation-Letter of recommendation from section chief or program director (including why the applicant is a good candidate to attend the workshop and plans for academic appointment if relevant). Please upload as an Adobe PDF document.

Upload Letter of Recommendation

Required

AGA-AASLD Academic Skills Workshop Application