Survey Request

Name or Responsible Party/Organization*
Title of Survey*
Email*
Phone*
Please Select Which Applies to You*
- I am a member of PES
- I am not a member of PES
- I am requesting this survey on behalf of a PES committee/SIG.
If requesting on behalf of a PES committee/SIG, please write which committee/SIG here
What is the purpose of your survey?*
Who is the intended audience?*
Is IRB approval required or planned?*
- Yes
- No
How do you plan to use the results? (e.g., information only, publication, etc.)*
What is your timeline for completion? (including closure of the survey and the time by which results will be analyzed)*
Text For Eblast*
How will you be submitting your survey?*
- Upload PDF or Word Document
- Enter Survey URL
Enter Survey URL
Upload Survey (PDF or Word only)
Max. file size: 128 MB.
Important Note/Agreement
- I have read the above note and agree to its terms
Please allow up to six weeks for full review of your survey by the Board of Directors and the Research Affairs Committee. PES will get back with you if further information is needed after the survey is initially reviewed. If your survey is accepted, please note that, while PES will send the email out to members on your behalf, you will be responsible for electronically creating the survey and providing it to PES (unless requesting survey on behalf of a PES committee/SIG). You may specify the timing of the reminder(s) emails, of which there will be no more two. Please be prepared to share the results with PES and its members upon request.

Survey Request

Survey Request

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