AAS Member Application "*" indicates required fields Step 1 of 2 50% Are you an existing AAS member looking to upgrade your member type?* Yes No To upgrade your membership, please contact Member Services at [email protected].Are you a current faculty member at your institution?* Yes No Do you currently practice/reside within the United States?* Yes No Select the date of your first faculty position as a non-trainee.*If you do not recall the exact date, please use your best estimate. MM slash DD slash YYYY Are you Active-Duty US Military?* Yes No Please select your current country of practice/residence.*AndorraUnited Arab EmiratesAfghanistanAntigua And BarbudaAnguillaAlbaniaArmeniaNetherlands AntillesAngolaArgentinaAmerican SamoaAustriaAustraliaArubaAzerbaijanBosnia And HerzegowinaBarbadosBangladeshBelgiumBurkina FasoBulgariaBahrainBurundiBeninBermudaBrunei DarussalamBoliviaBrazilBahamasBhutanBotswanaBelarusBelizeCanadaCongo, The Democratic Republic Of TheCentral African RepublicCongoSwitzerlandCote D'IvoireCook IslandsChileCameroonChinaColombiaCosta RicaCubaCabo VerdeCuracaoCyprusCzech RepublicGermanyDjiboutiDenmarkDominicaDominican RepublicAlgeriaEcuadorEstoniaEgyptEritreaSpainEthiopiaFinlandFijiFalkland Islands (Malvinas)Micronesia, Federated States OfFaroe IslandsFranceFrance, MetropolitanGabonUnited KingdomGrenadaGeorgiaFrench GuianaGhanaGibraltarGreenlandGambiaGuineaGuadeloupeEquatorial GuineaGreeceSouth Georgia, South Sandwich IslandsGuatemalaGuamGuinea-BissauGuyanaHong KongHondurasCroatia (Local Name: Hrvatska)HaitiHungaryIndonesiaIrelandIsraelIndiaIraqIran (Islamic Republic Of)IcelandItalyJamaicaJordanJapanKenyaKyrgyzstanCambodiaKiribatiComorosSaint Kitts And NevisKorea, Democratic People's Republic OfKorea, Republic OfKuwaitCayman IslandsKazakhstanLao People's Democratic RepublicLebanonSaint LuciaLiechtensteinSri LankaLiberiaLesothoLithuaniaLuxembourgLatviaLibyaMoroccoMonacoMoldova, Republic OfMontenegroSt MartinMadagascarMarshall IslandsMacedonia, Former Yugoslav Republic OfMaliMyanmarMongoliaMacauNorthern Mariana IslandsMartiniqueMauritaniaMontserratMaltaMauritiusMaldivesMalawiMexicoMalaysiaMozambiqueNamibiaNew CaledoniaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNiueNew ZealandOmanPanamaPeruFrench PolynesiaPapua New GuineaPhilippinesPakistanPolandSt Pierre And MiquelonPuerto RicoWest Bank/GazaPortugalPalauParaguayQatarReunionRomaniaSerbiaRussian FederationRwandaSaudi ArabiaSolomon IslandsSeychellesSudanSwedenSingaporeSt HelenaSloveniaSlovakia (Slovak Republic)Sierra LeoneSan MarinoSenegalSomaliaSurinameSao Tome And PrincipeEl SalvadorSint MaartenSyrian Arab RepublicSwazilandTurks And Caicos IslandsChadFrench Southern TerritoriesTogoThailandTajikistanTokelauTimor-LesteTurkmenistanTunisiaTongaEast TimorTurkeyTrinidad And TobagoTuvaluTaiwanTanzania, United Republic OfUkraineUgandaUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanSaint Vincent And The GrenadinesVenezuelaVirgin Islands (British)Virgin Islands (US)VietNamVanuatuWallis And Futuna IslandsSamoaKosovoYemenMayotteYugoslaviaSouth AfricaZambiaZimbabweYou Qualify for Senior Membership*Please check the box to continue Senior Member Are you currently a resident?* Yes No Are you a Chief Resident or Fellow?* Yes No Please select the one that best applies* I am in medical school. I am not a surgeon or faculty member, but participate in surgical research. Or, I support another of the academic missions (e.g., education) of a Department of Surgery. I am in a Fellowship. Would you like to be considered for Active or Candidate Membership?* Active Candidate Your Membership Category* HiddenMember Type*Active MemberActive Duty Military MemberInternational Tier 1International Tier 2International Tier 3International Tier 4Candidate MemberSenior MemberAffiliate MemberMedical StudentAbout YouApplicant Name* First Middle Last Suffix Degrees (MD, FACS, PhD, etc.) Gender* Male Female I choose not to disclose Ethnic Background* African American/African Asian Caucasian Hispanic Not Listed Multiracial I choose not to disclose Date of Birth* MM slash DD slash YYYY Primary Email Address* Secondary Email Address* Professional and Academic Contact InformationTitle / Position* Institution / Company Department / Division Department Chair Name First Middle Last Department Chair Email Work / Primary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and 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ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Work / Main Phone*Work FaxWebsite Home / Personal Contact InformationHome / Secondary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Cell Phone*Please use my personal address for AAS correspondence.* Yes No Education and TrainingHiddenUndergraduate DegreeHiddenUndergraduate Institution* HiddenUndergraduate Degree* HiddenUndergraduate Degree Year* Medical SchoolMedical School Medical School Degree Medical School Degree Year InternshipHiddenInternship Institution HiddenInternship Degree HiddenInternship Year ResidencyResidency Institution HiddenResidency Degree Residency End YearIf in progress, please enter the anticipated year of completion. FellowshipFellowship Institution HiddenFellowship Degree Fellowship End YearIf in progress, please enter the anticipated year of completion. SpecialtySpecialty* 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 RolesHiddenFellowship of the American College of SurgeonsHiddenFACS Year*If you are a Medical Student, Candidate, or Affiliate applicant, you may estimate or choose your member type in the drop down.AffiliateMedical StudentCandidate198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030HiddenFACS TypeAffiliateFellowCandidateAssociate FellowHiddenRoyal College of SurgeonsHiddenRoyal 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 StudentCandidate198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030HiddenBoard CertificationHiddenBoard Certificate Number HiddenBoard Certification YearIf you are a Medical Student applicant, you may estimate or choose your member type in the drop down.Medical Student198019811982198319841985198619871988198919901991199219941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242024202520262027202820292030HiddenBrief EssayHiddenBrief 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 Brochure HiddenOther HiddenWho can we thank for encouraging you to apply? Referrer's Email Address Promo Code Application Fee Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Share this:TwitterFacebookLinkedInPrint