ASDS — American Society for Dermatologic Surgery

What is a dermatologic surgeon?
One of the most innovative and progressive medical subspecialties, these ASDS experts perform medically necessary and cosmetic treatment and procedures to improve skin health and beauty.
From aging skin to skin cancer...
No one is more qualified to help than an ASDS member dermatologist. Each year, these skilled doctors perform 5 million cosmetic procedures and 2.6 million skin cancer treatments.
Conditions
One American dies of melanoma almost every hour
The good news: With early detection, melanoma has an almost 100 percent five-year survival rate. Schedule a free skin cancer screening today.
From crow's feet to spider veins...
You'll look and feel your best when ASDS member dermatologists combine their training and expertise with the widest range of options available.

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Partners in Professional Development Program Mentor Application

Program Date: July 15, 2013 - July 15, 2014
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip Code:
Office Phone:	(XXX-XXX-XXXX)
Cell Phone:	(XXX-XXX-XXXX)
* Email Address:

Choose one that best describes your practice:

Geographic area of mentor to mentee:

Please list the maximum number of mentees you would like to mentor in one year:

Please choose three topics below that you are interested in and willing to teach/advise for mentorship:
The challenges and rewards of a:
	Solo practice Single specialty group practice Multi-specialty group practice Academic practice
Practice management (policies and procedures, staffing, administration, billing)
Negotiating contracts, leases, etc.
Surgical Procedures
	Mohs micrographic surgery Cosmetic procedures Other
Public relations and public education
Public speaking at national meetings (ASDS, AAD, etc.)
Research
	Clinical trials Basic science
Professional society leadership (ASDS, AAD, State and regional derm society)
Volunteering
	Domestically Internationally Advocacy (political and patient safety)
Other
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