Attendance for the ASA Annual Meeting is by invitation only. To invite a non-member to the 128th Annual Meeting, simply fill out the information below to notify the secretary that you wish to extend an invitation.

*	First Name
*	Last Name
	Title
*	Organization
*	Address
	Address 2
*	City
*	State/Province	Outside of US & Canada Alabama Alaska Alberta (Canada) Arizona Arkansas British Columbia (Canada) California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba (Canada) Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick (Canada) Newfoundland (Canada) New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nova Scotia (Canada) Ohio Oklahoma Ontario (Canada) Oregon Pennsylvania Prince Edward Island (Canada) Quebec (Canada) Saskatchawan (Canada) Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*	Zip
*	Country	United States Canada --------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma/Myanmar Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Democratic Peoples Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakstan Kenya Kiribati Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Helena Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Province of China Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Islands Western Sahara Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe
	Phone
	Fax
*	Email
	Be advised that invitee is:	Surgical resident/fellow Colleague in surgery
*	Invited by:	Dr.
* - Required