Join the American Society

for Reconstructive Microsurgery

Thank you for your interest in becoming part of our esteemed community of reconstructive microsurgeons.

At ASRM, we are committed to advancing the field of reconstructive microsurgery through collaboration, education, and innovation. Below, you'll find everything you need to apply for membership, including the application steps, membership tiers, and the digital application form.

Application Process

Prepare Your Documents: Ensure you have your CV and other required materials ready.
Complete the Online Form: Fill out the digital application form below.
Sponsor and Endorsement: Include details of your sponsor and endorsers (if applicable).
Submit Your Application: Send the completed application along with supporting documents to the ASRM Central Office.
Approval and Confirmation: Your application will be reviewed, and you’ll be notified of the decision.

Membership Tiers and Fees

Active Membership: $450/year
For licensed surgeons actively practicing reconstructive microsurgery.
Associate Membership: $450/year
For professionals contributing to the field without active surgical practice.
Candidate Membership: Free
For trainees and early-career professionals pursuing a career in reconstructive microsurgery.

Submit Your Application

Which Membership category are you applying for?

Active

Associate

Candidate

PERSONAL INFORMATION

Name

First Name

Last Name

Designation(s)

Office Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone

(###)

###

####

Office Fax

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Preferred Mailing Address

Home

Office

Date of Birth

YYYY

Place of Birth

Citizenship

Please indicate your practice specialty/specialties

PROFESSIONAL QUALIFICATIONS

Pre-medical School Name

Location

Degree and dates attended

Add your degree and the dates attended at school

Medical School Name

Location

Degree and dates attended

Add your degree and the dates attended at school

Internship or PGY 1 Name

Location

Degree and dates attended

Add your degree and the dates attended at school

Residency Name

Location

Degree and dates attended

Add your degree and the dates attended at school

POST-RESIDENCY TRAINING IN MICRONEUROVASCULAR SURGERY

Add Inclusive Dates, Location, and Names of Director of Training Program

LICENSURE

Licensed to practice medicine in:

Add State or Country, Date, and License

BOARD CERTIFICATION

Specialty boards completed (if applicable)

Add Board and Date

MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS

Add Date Admitted and Organization

HOSPITAL AND UNIVERSITY STAFF AFFILIATIONS

Add From/To, Hospital or University and Dept., Name of Chief of Service, and your Position

(subsequent to completing fellowship)

PROFESSIONAL ACTIVITIES

What year did you begin practice after formal training?

N/A if it doesn't apply

How long in present position?

N/A if it doesn't apply

Number of operations performed last year?

N/A if it doesn't apply

How many of these microneurovascular cases?

N/A if it doesn't apply

PUBLICATIONS

List each of your publications related to microneurovascular surgery, including the title, author(s), journal inclusive pages, and year. Attach additional information if necessary

PRESENTATIONS RELATED TO MICRONEUROVASCULAR SURGERY

Include title of meeting, title of presentation, location, and date. Attach additional information if necessary

ATTENDANCE AT PREVIOUS ANNUAL MEETING(S)

Attendance at an Annual Meeting of the American Society for Reconstructive Microsurgery is required for application eligibility. Please list annual meetings you have attended

THE YOUNG MICROSURGEONS GROUP

The vision of the Young Microsurgeons Group is to unite young microsurgeons through active membership in the society and to enhance the voice and representation of younger members in the society. The Young Microsurgeon's Group will help coordinate educational experiences tailored to their membership and have a voice on select ASRM committees. Social activities will also be organized to foster camaraderie and provide opportunities to meet and interact with more senior members. All reconstructive surgeons who are candidate or full members who have been in practice for fewer than eight years are considered eligible.

Yes, I'm interested in participating in the YMG

No, thank you

INSTRUCTIONS

Applicants for Active or Associate membership must be sponsored by one Active member of ASRM, and endorsed by two other Active members. It is recommended that one of these individuals be from the candidate's local geographical area. Applicants for Candidate membership are to be proposed and sponsored by one Active or Associate member of the ASRM. Please print your sponsor’s name and information on the next page. Each sponsor and endorser will be contacted by the ASRM Central Office for a statement of support on behalf of the candidate

Sponsor

Name

First Name

Last Name

Phone

(###)

###

####

Endorser #1

Name

First Name

Last Name

Phone

(###)

###

####

Endorser #2

Name

First Name

Last Name

Phone

(###)

###

####

Your name / e-signature

Date

YYYY

Need Assistance?

f you have any questions about the application process or membership categories, please don’t hesitate to contact us.

Phone: 312-456-9579
Email: asrmoffice@gmail.com

Join the American Society

for Reconstructive Microsurgery

Thank you for your interest in becoming part of our esteemed community of reconstructive microsurgeons.

Application Process

Membership Tiers and Fees

Submit Your Application

Thank you for applying!

Our team will be in touch with next steps.

If you have any questions, reach out to our office at asrmoffice@gmail.com

Need Assistance?