Committee Assignment Acceptance

By submitting this form:

• You agree to serve ASGE in this capacity (see accompanying documentation for details of your appointment).
• Or you may decline the appointment.

I conclude that, to the best of my knowledge,

(Please select one of the following)

For additional questions, please contact: James Janssen, Governance Manager 
American Society for Gastrointestinal Endoscopy 
Email – 

3300 Woodcreek Drive 
Downers Grove, IL 60515