APDS Email & Survey Blast Request

APDS accepts requests to distribute a survey or announcement for consideration to be incorporated into a future APDS email blast. Requests must be submitted a minimum of 1 month before the requested distribution date to allow enough time for review. If accepted, the content will be approved for a one time distribution.

In order to submit a request, the following information must be provided below:

Contact Information
Brief explanation regarding the purpose for distribution to APDS members
Upload sample of desired content (word or pdf formats acceptable)
Complete Conflict of Interest Disclosure Assessment
SURVEY REQUESTS ONLY
- Confirmation of Completion Pilot Study (5+ Physician Cohort)
- IRB Approval

Questions?
APDS@lp-etc.com

1. Please complete your contact information: *This question is required.

First Name

Last Name

Company Name

City

State

Country

Email Address

Phone Number

2. Are you an APDS member in good standing? *This question is required.

If no, please list your company affiliation and title: *This question is required.

3. What type of request are you submitting? *This question is required.

What is the date of the event/educational activity you wish to promote? *This question is required.

5. What is the title of your survey? *This question is required.

6. In 350 words or less, please explain why the content of your survey/educational activity is relevant to APDS members and the purpose for seeking their potential participation: *This question is required.

Has this survey been piloted for clarity and timing with a cohort of at least five surgeons or physicians (medical students acceptable)? *This question is required.

Comments

Please upload IRB Approval for your requested survey (if applicable) (.pdf)

File: {{filename}} delete

7. Do you have a URL for your survey? *This question is required.

Please enter the URL to your survey

Please upload a copy of your survey (.pdf) *This question is required.

File: {{filename}} delete

8. Comments: