Younger Fellows Leadership Exchange
2015 Academic Surgical Congress
Younger Fellows
3-5 February 2015
Encore Las Vegas, Nevada
The Royal Australasian College of Surgeons
Name:
Year of Fellowship:
Contact Address:
Home Phone:
Bus Phone:
Mobile Phone:
Facsimile:
Email Address:
Please attach a short professional biography indicating your current involvement and
understanding of Younger Fellows’ issues and what you would hope to gain from the
Leadership Exchange.
STATEMENT (please tick):
I am a Younger Fellow of the Royal Australasian College of Surgeons (within ten years of gaining
Fellowship)
Signature: .........................................................................................
Date: ..../..../....
Submit your nomination to the attention of the Younger Fellows Secretariat by 15 September 2014
Post:
Royal Australasian College of Surgeons
College of Surgeons Gardens
250-290 Spring Street
EAST MELBOURNE VIC 3002
+61 3 9249 1259
Telephone:
+61 3 9276 7432
Facsimile:
Email: Younger.Fellows@surgeons.org
Thank you for your nomination for the 2015 Younger Fellows Leadership Exchange. Please note:
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Selection is finalised in September 2014. If your circumstances change and you wish to withdraw
your nomination, please contact the Younger Fellows Secretariat.
Airfares, transfers, accommodation and attendance at the AAS meeting are met by the Leadership
Exchange Program.
Selection is based on your understanding and involvement in College and Younger Fellows activities
as well as your leadership skills and experience.
The successful applicant will be required to present a paper at the AAS meeting and prepare a brief
report on their experience suitable for publication in Surgical News.
More information (including the TOR) is available on the College website