21st Annual Academic Surgical Congress

February 11-13, 2025 | Virgin Hotels Las Vegas, Las Vegas, NV

ASC Moderator Sign Up

Thank you in advance for using the form below to submit your availability to serve as moderator for the ASC Annual Meeting! Please note that completion of this form does not automatically mean that you will be invited to moderate; we will follow up with you in the fall with formal next steps.

Please keep in mind that the more date/time options you select for your availability below, the more likely you are to be selected to moderate!

If you have any questions or concerns, please email [email protected].

ASC Moderator Form

Name(Required)
Academic Rank(Required)

Gender(Required)

Society Membership (check all that apply):(Required)
Please select when you are available to moderate at the 2025 ASC Meeting (check all that apply):(Required)
Appropriate session types (check all that apply):(Required)
Appropriate topics (check all that apply):(Required)