MEMBERSHIP APPLICATION SUBMISSION FORM
Please review the following information (also present on the AGOS website) to aid you in completing your application by June 15.

Before you begin your application, please make sure you have the following items to upload:

1) Completed Membership Application (obtain from AGOS website)
2) Current CV
3) Current Biosketch
4) Professional; high-resolution photo
5) Two letters of support from mentors


Once you begin your application, you must be prepared to complete at that time.  You will be unable to save and continue at another time.

Start Application
 
First Name: *

 
Middle Initial (if applicable):

If none, click Enter.
 
Last Name: *

 
Designation (MD, PhD): *

 
Full Name of Institution: *

 
Sub-specialty Interest: *

(Please select ONE)

 
1st Mentor NAME: *

 
2nd Mentor NAME: *

 
Number of Years Since Completing Residency of Fellowship: *

 
Next: Upload Your Files

Click "Continue".
 
Please upload your completed membership application *

(MS Word or PDF format preferred)
 
Please upload a current CV *

(MS Word or PDF format preferred)
 
Please upload a current bio-sketch *

(MS Word or PDF format preferred)
 
Please upload a high-resolution, professional photo *

(JPEG or PNG formats preferred)
 
Please upload your 1st Mentor support letter: *

(MS Word or PDF formats preferred)
 
Please upload your 2nd Mentor support letter: *

(MS Word or PDF formats preferred)
 
Please click "Submit Application" below.

Thank you for submitting your application!
You will receive an email notification confirming your submission shortly from notifications@typeform.org. Please contact agos@agosonline.org if you have any questions regarding the membership application process.

Membership Approval Process Timeline (approximate):

- June 15: Deadline to accept applications

- June thru July: Fellowship Committee reviews applications

- August: Fellowship Committee approve final applications to be presented to the AGOS Council

- September: AGOS Council reviews/approves final membership applicants; to be voted on by the AGOS membership

- October: All applicants are notified of membership application status (selected / non-selected)

- November thru December: Membership votes on selected member applicants

- January: Voting closes; member applicants are notified via email on final approval; membership begins Jan. 1
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