Executive Director: Philip R. Schauer, MD, Director, Advanced Laparoscopic and Bariatric Surgery Cleveland Clinic Date:    February 21-26, 2011 The Grand America Hotel, Salt Lake City, Utah Register Conference Travel/Lodging MISS LIVE Contact Us Home
Schedule-at-a-Glance Colon Procedures Foregut Surgery Hernia Morbid Obesity Attendee Brochure Faculty Invite a Colleague MISSLIVE  Webcasts MISS eNews MISS Press Release	Online Registration Form 1. General Information DISCOUNT CODE FIRST NAME LAST NAME DEGREE  MD    DO    FELLOW    PA    NP    RN    OTHER, PLEASE SPECIFY   Affiliation Organization / Institution Specialty Street Address Is this your:    Home   Office City State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Other ZIP Country Email   By providing your email address, you are granting CONTEMPORARY SURGERY permission to contact you via email to update information. DAYTIME PHONE FAX 2. Profile 1. SURGICAL EXPERIENCE IN YEARS:  0 to 1    1 to 3    3 to 5    5 to 10    >10   2. TYPE OF PRACTICE:  SOLO    GROUP (3 physicians or more)      PARTNERSHIP (2 physicians)    HOSPITAL      OTHER, PLEASE SPECIFY   3. HOW MANY SURGICAL PROCEDURES DO YOU PERFORM IN A TYPICAL WEEK? (Including inpatient, ambulatory, and same-day)  NONE    1 TO 5    5 TO 10    10 TO 15    15 TO 20    > 20 4. How many years have you attended MISS?  First time    Years