HTML Preview Joint Sponsorship Application page number 1.
AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS
JOINT SPONSORSHIP APPLICATION
APPLICANT INFORMATION
Organization Name:
Meeting Name:
Meeting Dates:
Meeting Facility:
City, State:
CME Contact (must be a neurosurgeon):
Address:
City:
State:
ZIP Code:
Telephone:
Fax:
Email:
Administrative Contact (if applicable):
Telephone:
Fax:
Email:
WEBSITE CONTACT INFORMATION
Your meeting will be posted on the AANS Meetings Calendar on the AANS website (unless you advise otherwise).
Please provide the contact for your meeting registration and information and a link to your registration brochure or
website.
Name:
Phone:
Email:
Website URL:
PAYMENT CONTACT INFORMATION
The $500 non-refundable application fee is due with the application and the joint sponsorship service fee
payment will be expected within 60 days after your meeting date. Invoices should be sent to:
Name:
Email:
Address:
City:
State:
ZIP Code:
EDUCATIONAL PLANNING
Mission Statement: (Brief description of purpose, function or mission statement.)
Problem in Practice (i.e. Practice Gap): A professional practice gap is defined as the difference between actual
and ideal performance and/or patient outcomes. What is the practice based problem your meeting will address?
And how are your learners involved? A problem in practice (or gap) does not have to be clinical. It can also be
administrative, clerical or communication related.
Educational Needs: List each of the educational needs of your target audience based on professional practice
gap(s) that you found. The identified need(s) should be based on competence levels. Competence is the ability to
apply knowledge, skills, or judgment in practice if called upon to do so. (i.e. What do you need to teach to close
the gap?)