AAS Member ApplicationRevised 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. Step 1 of 250%Are you an existing AAS member looking to upgrade your member type?*YesNoTo upgrade your membership, please contact Member Services at membership@aasurg.org.Are you a current faculty member at your institution?*YesNoPlease select your current country of practice/residence.*United StatesAndorraUnited 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 AfricaZambiaZimbabweSelect the date of your first faculty position.*If you do not recall the exact date, please use your best estimate. Date Format: MM slash DD slash YYYY Senior Member*Senior MemberAre you Active-Duty US Military?*YesNoAre you currently a resident?*YesNoAre you a Chief Resident or Fellow?*YesNoPlease 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?*ActiveCandidateYour Membership Category*Member 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*MaleFemaleI choose not to discloseEthnic Background*African American/AfricanAsianCaucasianHispanicNot ListedMultiracialI choose not to discloseDate of Birth* Date Format: MM slash DD slash YYYY 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 YearSpecialty* 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 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.