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Application

Please fill out the following form to submit your application for Fellowship (Membership), or click here for an Adobe Acrobat version of the application.

If you are choosing the Acrobat version, please send the completed form to the National Section President or Secretary in your country. If the National Section officers are unknown to you, click here to view the names. Or if you prefer, send the completed application to the International College of Surgeons at the address or to the fax number shown below at left.

Membership Categories
Candidates shall be graduates of an approved School or College of Medicine and shall be of unquestionable moral and ethical values.

Fellow:
Candidates shall have satisfactorily completed an approved postgraduate training program and shall have the required number of years of practice to conform to the standards of the respective national section.

Associate:
Candidates may not have fulfilled all the requirements of the standards required for Fellowship by the respective national section, but shall be considered a candidate for such qualification in the future as stipulated by the respective national section.

Junior:
Must have completed the first postgraduate year and must be presently pursuing a definite plan of training in surgery or related field.

 

Electronic Application




First Name(s)-Prenom(s)-Nombre(s)











Your Permanent Residence (country)

Your Current Medical License(s) (country)

Date of Certification

Your Professional Specialty

References

Please list three (3) surgeons familiar with your work. References will preferably be provided by the Chair of the Surgical Department in which you work, a surgical colleague who works in your hospital or a Fellow in good standing with the ICS. All information received will be treated with the utmost regard for confidentiality.

Reference #1

Name

Address

City

State

Postal Code/Zip

Country

Email

Fax

Reference #2

Name

Address

City

State

Postal Code/Zip

Country

Email

Fax

Reference #3

Name

Address

City

State

Postal Code/Zip

Country

Email

Fax

Sponsor (if recommended by a current ICS Fellow)

Name

City/Country