*Available dates will be shaded a dark grey.
*Webinars are shaded in orange.
* = Required Field
NOVOSTITCH Surgeon Choice 1:*Bankston MD, Larry (Chip) Brooks MD, Kenneth Chang MD, Spencer Colyvas MD, Nicholas Faucett MD, Scott Flanigan MD, David Gomoll MD, Andreas Kurzweil MD, Peter Larson MD, James Liu MD, Joseph McIntyre MD, Louis Murphy MD, Randall Lee Nepple MD, Jeffrey Padley DO, Grant Patel MD, Ronak Ranawat MD, Anil Richardson MD, Lars Saliman MD, Justin Sherman MD, Seth Strauss MD, Eric Strickland MD, Sabrina Van Thiel MD, Geoffrey Vaughn MD, Zachary White MD, Jared
NOVOSTITCH Surgeon Choice 2:*Bankston MD, Larry (Chip) Brooks MD, Kenneth Chang MD, Spencer Colyvas MD, Nicholas Faucett MD, Scott Flanigan MD, David Gomoll MD, Andreas Kurzweil MD, Peter Larson MD, James Liu MD, Joseph McIntyre MD, Louis Murphy MD, Randall Lee Nepple MD, Jeffrey Padley DO, Grant Patel MD, Ronak Ranawat MD, Anil Richardson MD, Lars Saliman MD, Justin Sherman MD, Seth Strauss MD, Eric Strickland MD, Sabrina Van Thiel MD, Geoffrey Vaughn MD, Zachary White MD, Jared
NOVOSTITCH Surgeon Choice 3: (You must have 5 confirmed surgeon attendees before we request the following surgeons ):*Bankston MD, Larry (Chip) Brooks MD, Kenneth Chang MD, Spencer Colyvas MD, Nicholas Faucett MD, Scott Flanigan MD, David Gomoll MD, Andreas Kurzweil MD, Peter Larson MD, James Liu MD, Joseph McIntyre MD, Louis Murphy MD, Randall Lee Nepple MD, Jeffrey Padley DO, Grant Patel MD, Ronak Ranawat MD, Anil Richardson MD, Lars Saliman MD, Justin Sherman MD, Seth Strauss MD, Eric Strickland MD, Sabrina Van Thiel MD, Geoffrey Vaughn MD, Zachary White MD, Jared
Meeting Time:*
Sales Rep Name:*
Sales Rep Email:*
Sales Rep Cell Phone:*
DOS/TM or TM Name:*
Additional Comments:*
Sales Rep or MDM’s will create the invitation for the Dinner Symposia.
I understand that sales rep is responsible for booking and paying for dinner.
Please confirm you have read below: I understand that this date and surgeon request is NOT confirmed until I receive notice from Michelle Turner Medical Education Program Manager michelle.turner@smith-nephew.com
Please note: Smith & Nephew and its agents adhere to the AdvaMed Code of Ethics. Visit the AdvaMed website at www.advamed.org to review this policy. Attendance by federal, state or local US officials requires the authorization and approval of the employing agency.