Clone of 2025 ASA MSC Alternate Delegate Submission Form

Alternate Delegate Submission Form

Please submit all materials by August 4, 2026.
ASA Medical Student Component House of Delegates

Sunday, October 12, 2025 - San Antonio, TX

Delegate Information: Alternate Delegates must be ASA medical student members and may be of any year in medical school. Alternate Delegate term begins August 1 and concludes June 30 of each year. Alternate Delegates have consulting privileges with the voting Delegate from their medical school on issues presented at the ASA MSC House of Delegates Annual Meeting. Alternate Delegates will only be able to vote if the Delegate is NOT present at the meeting.

Delegate Responsibilities: Responsibilities of all alternate delegates include attendance at the ASA ANESTHESIOLOGY annual meeting in order to participate in the ASA Medical Student Component House of Delegates Meeting on Sunday, October 18, 2026. The Alternate Delegate is responsible for the assisting in the recruitment of medical students, within their respective medical school, into the ASA MSC. Alternate Delegates are elected into this role by their Anesthesiology Interest Group at their respective medical school. The Alternate Delegates will be responsible for supporting the Delegate from their medical school in contacting their state societies and developing/maintaining a membership with them (if applicable).
ASA Member ID
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email Address
non-institution email preferred
Medical School Name
Medical School City/State
Graduation Year
AIG Faculty Member Name

First NameLast NameSuffix
AIG Faculty Member E-Mail
example@example.com
Letter of Recommendation:

Browse Files

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Candidates are required to obtain and upload a letter of support from their anesthesiology faculty mentor or another qualified faculty member. Applications will not be considered until a Letter of Recommendation is submitted.
After you click submit, you will receive a confirmation of your application via email.
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