AAS Member Application All members are invited to participate actively in all of the Association's functions by submitting abstracts for scientific presentation, attending the Annual Meetings, and discussing papers presented at meetings in their area of interest. Member Type**If you are seeking to upgrade from your current membership type please reach out to the office at membership@aasurg.org*Active MemberActive InternationalCandidate MemberSenior MemberAffiliate MemberMedical StudentAbout YouApplicant Name* First Middle Last Suffix Degrees (MD, FACS, PhD, etc.)Gender*MaleFemaleDate of Birth* Primary Email Address* Secondary Email Address* Professional and Academic Contact InformationTitle / PositionInstitution / CompanyDepartment / DivisionDepartment Chair Name First Middle Last Department Chair Email Work / Primary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Work / Main Phone*Work FaxWebsite Home / Personal Contact InformationHome / Secondary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Cell Phone*Please use my personal address for AAS correspondence.*YesNoEducation and TrainingUndergraduate DegreeUndergraduate Institution*Undergraduate Degree*Undergraduate Degree Year*Medical SchoolMedical SchoolMedical School DegreeMedical School Degree YearInternshipInternship InstitutionInternship DegreeInternship YearResidencyResidency InstitutionResidency DegreeResidency YearFellowshipFellowship InstitutionFellowship DegreeFellowship YearWhat is the year you first held a faculty position?*If you are a Medical Student or Candidate applicant, you may estimate or choose your member type in the drop down.Med StudentCandidate198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030Specialty* General Surgery Anesthesiology Cardiac/Thoracic Surgery Laparoscopic Surgery Neurosurgery Orthopedics Pediatric Surgery Ophthalmology Otorhinolaryngology Pathology Plastic / Reconstructive Surgery Surgical Oncology Thoracic Surgery Transplantation Trauma / Critical Care Vascular Surgery Urology Colon and Rectal Surgery Endocrine Surgery Ear / Nose / Throat Medical Student (n/a)Academic QualificationsAcademic HonorsPresent PositionsInstitutional PositionsArea(s) of Investigative Research:Area(s) of Clinical Interest:Surgical and Medical Society Memberships and RolesFellowship of the American College of SurgeonsFACS Year*If you are a Medical Student, Candidate, or Affiliate applicant, you may estimate or choose your member type in the drop down.AffiliateMedical StudentCandidate198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030FACS TypeAffiliateFellowCandidateAssociate FellowRoyal College of SurgeonsRoyal College of Surgeons YearIf you are a Medical Student, Candidate, or Affiliate applicant, you may estimate or choose your member type in the drop down.AffiliateMedical StudentCandidate198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030Board CertificationBoard Certificate NumberBoard Certification YearIf you are a Medical Student applicant, you may estimate or choose your member type in the drop down.Medical Student198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030Brief EssayBrief Essay*Please explain why it's important for you to become a member of the Association for Academic Surgery (50 words or less.)Referral InformationHow did you hear about the AAS?* AAS Meeting Advertisement in the JSR My Program Chair My AAS Institutional Representative Colleague AAS Web Site AAS Mailing AAS Membership BrochureOtherWho can we thank for encouraging you to apply?Referrer's Email Address Promo Code Application Fee $0.00 Credit Card*American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. 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