Clone of 2025 ASA MSC Delegate Submission Form

ASA MSC Delegate Submission Form

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

Sunday, October 18, 2026 - San Diego, CA

Delegate Information: Delegates and alternates must be ASA medical student members and may be of any year in medical school. Delegate term begins August 4 and concludes June 30 of each year. The Delegate has voting privileges on issues presented at the ASA MSC House of Delegates Annual Meeting. Delegates will only be able to vote if present at the meeting.

Delegate Responsibilities: Responsibilities of all 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 Delegate is responsible for the recruitment of medical students, within their respective medical school, into the ASA MSC. Delegates are elected into this role by their Anesthesiology Interest Group at their respective medical school. The delegates will be responsible for 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
AIG Faculty Member Full Name

First NameLast NameSuffix
AIG Faculty Member Contact Email
example@example.com
Graduation Year
Letter of Recommendation:

Browse Files

Cancelof
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.
Should be Empty: