Application for International Membership

Who should apply for the SAGES International Group?

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.

Applicant Information
Suffix
Institution Information
Mailing Address
Is this address located at the Institution above?
Additional Information
Gender
Please mark your specialty
Indicate your surgical practice as it is now defined:
Education
College / University
Medical / Nursing School
Postgraduate Training
Internship
Residency
Fellowship
Other
Licensure / Certification

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

Has your medical license ever been suspended or revoked in any state?
Have your privileges ever been suspended or changed?
Board Certification

If applicable, a copy of your board certificate(s) must be submitted to the SAGES office in order to complete your application.

Society Memberships
Select all that apply
Endoscopic / Laparoscopic Training
Was flexible endoscopy included in your surgical residency or training?
Was laparoscopic surgery included in your surgical residency or fellowship training?
Current Endoscopic / Laparoscopic Experience
Flexible GI Endoscopy (Approximate Number)
EGD
ERCP
PEG
Colonoscopy
Laparoscopic General Surgery (Approximate Number)
Laparoscopy (Diagnostic or Emergency)
Laparoscopic Cholcystectomy
Laparoscopic Choledochoscopy
Upper GI Laparoscopic Surgery
Lower GI Laparoscopic Surgery
Laparoscopic Solid Organ Removal
Academic Appointments

Please begin with the most recent.

Academic Appointment 1
Academic Appointment 2
Academic Appointment 3
Academic Appointment 4
Academic Appointment 5
Hospital Appointments

Please begin with the most recent.

Hospital Appointment 1
Hospital Appointment 2
Hospital Appointment 3
Hospital Appointment 4
Hospital Appointment 5
Tier

International applicants from developing countries may elect to pay lower annual dues in exchange for some reduced services. Full information and lists of countries that qualify for tiers are available from this link. In the interest of fairness, we ask that if your economic status warrants, you elect to pay the full membership fee of $285 per year.

Letters of Recommendation

Please note: letters below must be from different people. You may not have the same person fulfill multiple roles.

Letters of recommendation have been requested from:

Attachments
Signature

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.

Meet A Member?

Would you like to meet a SAGES member?

Submission