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Application for Fellowship   (Click here if you are a surgical resident - all specialties)

Please fill out the application completely.   Omissions will increase processing time.

Only submit this application if you are licensed and practicing in the United States.

Surgical residents in training may apply for Junior Fellowship by clicking HERE.

PAs and NPs may apply for Allied Membership by clicking HERE!

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By clicking submit you agree to the following terms:

Recognizing that an investigation of my qualifications is necessary prior to becoming a member of the ICS, I hereby authorize said College, its Qualifications and Interim Council,officers, agents, employees and representatives to seek any and all documents at their discretion to evaluate this application for membership.

I hereby authorize all persons, firms, corporations - including and without limitation hospitals, medical associations and physicians - to divulge to the ICS any information, letters, or written material relating in any manner to my professional qualifications, clinical competency, character or any other matter that is directly or indirectly related to this application. With respect to any disclosures, discussions, reports, communications, and the evaluations made herewith, I do hereby release the ICS, its Qualifications and Interim Council, officers, agents, employees and representatives and any other persons, firms, corporations, hospitals or individuals delivering any information or written material to any of them from any and all civil liability as a result of any actions or inactions by any of them as a result thereof.

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