Survey Request Form to AANA Membership

Survey Request Form to AANA Membership
Name*

First NameMiddle NameLast NameSuffix
Institution / Affiliation (if any)
Email*
example@example.com
Research Title*
The following criteria must be met and agreed to in order for AANA to consider requests to send survey links by email to its members:
- Surveys must have IRB or REB approval for consideration.
- The survey requester must be a member of AANA.
- The survey objectives must be defined and in alignment with the goals of AANA. The survey may not be intended for commercial use or commercial product development.
- A sample of the survey must be provided to and approved by AANA.
- The specific target audience must be defined should the requester wish to target a specific group of AANA members.
- A time line for data collection must be established.
- Should the requester wish to publish the survey data in a peer-reviewed scientific journal, Arthroscopy will have the first right of refusal.
- The survey results will be made available to AANA for its use.
The above criteria has been met.*

YesNo
Please include your purpose and hypothesis for the AANA Research Work*
Enter your survey link*
example: https://www.surveymonkey.com/123456789
Number of survey questions*
Define your target audience*
Provide us with timeline for collection*
Is your request a part of current AANA funded research?*

YesNo
Please attach an IRB or REB approval form from the institution granting approval*

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By entering your full name below, you are signing and verifying all information on this form is correct.*
Date

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