92%


Questions marked with a * are required
There are a limited number of spaces available and registrations are reviewed by the Masterclass Mentors. Priority will be given to surgeons who best fit the targeted learner criteria identified on the TFG Masterclass webpage. By submitting your application, you are confirming your availability to attend the onsite components of the program in Salt Lake City Utah on September 27 and 28, 2024.
Personal Details:
How many years have you been in practice post training?
Where is your primary surgery location?

What is your average ANNUAL volume of cataract surgery?
Approximately, how many patients do you see PER MONTH that you would consider as having glaucoma?
What is the number of sustained release glaucoma procedures you’ve performed in the past 12 month?
If none, about how many sustained release glaucoma procedures were performed over the past 12 months in the primarily location where you perform your cataract surgery?
What is the number of MIGS procedures you’ve performed in the past 12 month?
If none, how many MIGS procedures were performed over the past 12 months in the primarily location where you perform your cataract surgery?
Give a brief description of why you would like to be considered for this Masterclass program and your goal to achieve within this program (500 words or less)
Acknowledgement

I acknowledge that as part of the application process, I am committing to complete all online modules and attend the in-person case review, wet labs, workshops, and exam in Salt Lake City, Utah, on September 27th and 28th.  I also agree to pay the $199 course registration fee if accepted. Course fee will be waived for fellows. TFG will cover the costs of hotel accommodations on September 26th and 27th, breakfast, lunch, and dinner on September 27th, and breakfast and lunch on September 28th. All other travel costs will be the applicant's responsibility. 
Please add any questions, concerns, or requests you would like to accompany your application.  
Are you willing to have your name and email address shared with independent education supporters of this program if you are accepted to participate?
Powered by QuestionPro