Mock Oral Board Examination Secondary Registration Form

FIRM DEADLINE: Thursday, November 1 (if not sold out)

To register for the Mock Oral Examinations and to be eligible for the Gore sponsored scholarship, you must complete the following:

  1. Register for the Annual Meeting. Meeting registration (under separate subscription) is required unless excused by a letter from your Program Director.
  2. Complete this form. All fields in bold below are REQUIRED to finalize your registration.
PLEASE NOTE: Mock Oral Exam Registration is not on a first come first serve basis, you will be notified about the status of your application in the beginning of December.

Attendee Information
First Name Last Name
Hospital/Affiliation
Address
City
State/Province
Postal Code
Country
Phone
Fax
Email Address (required for confirmation)
Which Training Program are You Currently In?
General Surgery Residency
Vascular Surgery Residency Integrated Program (0+5)
Vascular Surgery Residency Program 5+2
Other:
Expected Date of Graduation:

Vascular Surgery Program Information
Program
Year in Residency
Program Director
Program Director's Email
Department Chair
Department Chair's Email
State/Province
Postal Code
Country
Phone
Fax
General Surgery Program
 
Scholarship Reimbursement
Check should be made payable to: Program Yourself
 
 

 
 
Southern Association for Vascular Surgery
500 Cummings Center, Suite 4400, Beverly, MA 01915
Phone: 978-927-8330 | Fax: 978-524-0461