Representative Request Form

Representative Request Form

In order to facilitate the nomination of ASCO representatives for organizations’ guideline panels, please complete the form below. Please note that it may take up to a month to receive representative nominations.

Please be advised: Requesting or receiving a representative for a guideline panel IS NOT an endorsement of the guideline or of the requesting organization by ASCO. ASCO does not review or approve guidelines as a result of nominating representatives unless a separate joint development agreement is in place.

Please contact ASCO, or fill out the form linked here if your organization wishes to consider joint development of a guideline.

Email guidelines@asco.org with questions.

Requester Name*

Requester Email*

Requesting Organization*

Guideline Title*

Number of ASCO representatives requested*

Expected time commitment required from representatives*

If known, please indicate the date by which you need nominees

Type of expertise or subspecialty requested*

(e.g. medical oncologist with expertise in breast cancer specializing in young adults)

Any geographic, demographic, or setting specific preferences*

(e.g. within the USA, rural, academic versus community practice, diversity criteria, national or international, specific geographical locations, etc.)

Is travel anticipated? If so, are travel costs covered by your organization?*

ASCO does not cover travel costs for these requests.

Please indicate any known limitations that would preclude a nominated representative from participating on this guideline, such as specific disclosures*

Please provide a short summary of the guideline topic*

(Optional) Provide suggested representatives and their contact information below.

Please note, while suggested representatives will be considered, it is not a guarantee of nomination by ASCO

Suggest Representative #1: Name

Suggest Representative #1: Specialty

Suggest Representative #1: Institution

Suggest Representative #1: Email

Suggest Representative #2: Name

Suggest Representative #2: Specialty

Suggest Representative #2: Institution

Suggest Representative #2: Email

Suggest Representative #3: Name

Suggest Representative #3:Specialty

Suggest Representative #3:Institution

Suggest Representative #3:Email

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