ACG Logo

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD
20827-2260
(301) 263-9000

ACG MEMBER EMPLOYER/REPRESENTATIVE QUESTIONNAIRE

* = Required

Company Contact Information

*Contact First Name *Contact Last Name
*Company Name
*Mailing Address
Mailing Address 2
*City *State
*Zip/Postal Code *Country
*Phone *Fax
Cell Phone
*E-mail
*Member First Name *Member Last Name

Position Profile

*Type of Position        
Private Practice Academic Corporate
    Practice with 5 or fewer MDs       Pure Clinician      
    Practice with 6 or more MDs       Clinical Educator    
    Multi-Specialty Group       Basic Science Researcher    

Number of Positions Available
Full Time Part Time
*The position is located in:
Northeast (CT, MA, ME, NH, NJ, NY, PA, RI, VT)
South (AL, AR, DC, DE, GA, FL, KY, LA, MD, MS, NC, SC, TN, VA, WV)
Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, OK, SD, TX, WI)
West (AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY)
Canada
*Position Description (limit to 2000 characters)
*Position Requirements/Qualifications (limit to 2000 characters)
*Will you be attending the ACG Meeting?
Yes No
If yes, do you have a Booth on the Exhibit Floor
Yes, Space # No
If you plan on conducting interviews on site,
please indicate the date and times that you are available:
Sunday, Oct 5th
Monday, Oct 6th
Tuesday, Oct 7th
Wednesday, Oct 8th
Hotel/Location and Phone Number during ACG Meeting
*Would you like to be contacted after the meeting with copies of the applicants' postings?
Do not contact me after the meeting
E-mail postings that match the position criteria
Mail me a copy of postings after the meeting