ACG International Faculty Request Form - American College of Gastroenterology

If your international GI organization would like to request that ACG sponsor faculty at an international meeting, please fill out the form below.

Society Information
Organization Name*
President*
Country*
Website*
Conference Details
Conference Name*
Conference Chairman*
Conference Dates*
Conference Location*
Primary specialty of target audience.*
Estimated Number of Attendees*
Type of Attendees (e.g. Gastroenterologists, Hepatologists, Primary Care Physicians, Advanced Practice Providers, etc.)
Number of Attendees at the Previous Meeting (if held on a recurring basis)*
Topic(s) for ACG Faculty Presentation*
Requested Faculty (NOTE: The ACG President will select the faculty that will represent ACG, but will consider requests)*
The reason for the application and why ACG should sponsor faculty for your conference.*
Has ACG sponsored faculty for a prior society meeting? If yes, what meeting and when?*
Contact Person
Let us know who in your organization we can contact to follow up on this request.
Contact Person's Name*
Contact Person's Email Address*
Contact Person's Phone Number*
Documents to Upload
Official Letter of Request*
Accepted file types: doc, docx, pdf, Max. file size: 50 MB.
(must be Microsoft Word document or a PDF)
Conference Agenda*
Accepted file types: doc, docx, pdf, Max. file size: 50 MB.
(must be Microsoft Word document or a PDF)
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Society Information