Application for Membership

Step 1 of 7

Are you a practicing surgeon?(Required)

Yes

Please select your current country of practice/residence(Required)

Are you Board Certified?(Required)

Yes

Are you currently in a surgical residency or fellowship program?(Required)

Yes

Please select the option that most closely matches(Required)

I am still in Medical School

I am a PA, NP, PhD, surgical educator or involved in surgical research

I am a physician involved with MIS but I am not a surgeon

Your Membership Category(Required)

What member type are you applying for?

Active Membership Requirements

Practice within the United States, Canada or Puerto Rico.
License to practice medicine in his/her state, province or country. Applicant may be in government service not requiring licensure.
Certification by the American Board of Surgery, the American Board of Osteopathic Surgery, fellowship in the Royal College of Surgeons, Canada, or fellowship in the American College of Surgeons

Associate Active Membership Requirements

Practice within the United States, Canada or Puerto Rico.
License to practice medicine in his/her state, province or country. Applicant may be in government service not requiring licensure.
Certification by an American Surgical Specialty Board (other than certifications recognized for eligibility for regular SAGES Active Membership) which is a member of the American Board of Medical Specialties and which is appropriate to the applicant’s specialty practice, or certification in gastroenterology by the American Board of Internal Medicine, or an appropriate equivalent specialty certification by the Royal College of Physicians and Surgeons of Canada.

International Membership Requirements

Endoscopic/Laparoscopic surgeons outside the US, who are licensed to practice medicine and have the equivalent of a Surgical Board Certificate for the country in which they practice.
Endoscopic/Laparoscopic surgeons who were originally trained & certified to practice surgery in another country, and are now licensed and practicing in the US; but who do not meet the American Board requirements for Active Membership.

Affiliate Professional Membership Requirements

For Nurses, RNFAs, Nurse Practitioners, Physician Assistants, Surgical Educators, Engineers, and others devoted to a career in healthcare and actively participating in the practice of, or research in, endoscopic or minimal access surgery.

Candidate Membership Requirements

Graduation from a medical school acceptable to SAGES.
Current status as either:
- A resident or fellow enrolled in an accredited program of surgical education or research, or
- A surgeon who has completed an accredited surgical education program and is awaiting Board certification.

Medical Student Membership Requirements

Must be currently enrolled in Medical School.

Contact Information

Name(Required)

Prefix First Middle Last Suffix (II, III, IV, Jr, Sr)

Degrees (MD, PhD, DO, FACS, FRCS etc.)

Primary Email(Required)

Enter Email Confirm Email

Secondary Email(Required)

Enter Email Confirm Email

Office Phone(Required)

Fax

Cell Phone(Required)

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Institution/Company Name(Required)

Institution / Company Name(Required)

Department

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this your business or home address?(Required)

Business

Home

Additional Information

Date of Birth(Required)

Country of Birth

Licensure / Certification

A copy of your medical license must be submitted to the SAGES office in order to complete your application.

Do you have a medical license?(Required)

Yes, I have a medical license.

No, I do not have a medical license.

In what country are you licensed to practice medicine?(Required)

In which state are you licensed to practice medicine?(Required)

Registry Number(Required)

Medical License Expiration Date(Required)

Has your medical license ever been suspended or revoked in any state or country?(Required)

Yes

Please provide a brief explanation as to why your license was revoked or suspended.(Required)

Have your privileges ever been suspended or changed?(Required)

Yes

Please provide a brief description of how your privileges changed.(Required)

Please upload a copy of your medical license.(Required)

If you do not have a copy on hand, please use the “Save and Continue” option at the bottom of this page. A link will be sent to your email, allowing you to resume your application.

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 600 MB.

Board Certificate Registry Number

Certificate Expiration Date

Please upload a copy of the certification you designated above.(Required)

PLEASE NOTE: All documents must be submitted in English or with an English translation.

Accepted file types: jpg, gif, png, pdf, Max. file size: 600 MB.

Academic and Hospital Appointments

Is this a Academic or Hospital Appointment?	Institution	Start Year	End Year	Actions

There are no Appointments.

Letters of Recommendation

Please provide the name and email address of a surgical instructor or surgeon colleague who is familiar with your practice or work. If you have a letter of recommendation from them you may upload it now. If you do not have a letter of recommendation to upload, a link will be emailed to them, asking them to complete a brief online form regarding your application to SAGES.

Do you have a copy of your letter of recommendation available now?(Required)

Yes

Please upload your letter of recommendation.(Required)

Accepted file types: jpg, png, pdf, Max. file size: 600 MB.

Surgical Colleague(Required)

First Last

Surgical Colleague Email(Required)

Please provide your colleague’s email address. If you did not upload a letter of recommendation above, they will be emailed a link to complete a brief online form regarding your application to SAGES. Please alert them to look for the email within 24 hours of submission of this form.

Program Director or Chair(Required)

First Last

Program Director or Chair Email(Required)

Please provide the name and email address of your Program Director, who will be required to confirm your enrollment in residency or fellowship training. If you have a letter confirming your enrollment from them you may upload it now. If you do not have a letter to upload, a link will be emailed to them, asking them to complete a brief online form verifying their enrollment.

Finalize Your Application

How did you hear about SAGES?

Signature(Required)

By typing my full name in the space below, I authorize the Society of American Gastrointestinal and Endoscopic Surgeons to obtain information from societies, hospital staffs, members, and any other source regarding this application and my qualifications for membership, which information will be kept confidential by the Society.

Application Fee

Application Fee(Required)

Price:

Total

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Conditional Total

Promo Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

APPLICATION REVIEW PROCESS: The SAGES Membership Committee meets quarterly, in January, March/April, July and October, to consider new members. Applications must be complete one month prior to be included in that quarter’s review.

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