Online Application for Active Membership

All fields marked with an asterisk (*) are required.

Personal Information First Name: *
Middle Name:
Last Name: *

Business Information Name of Business/ Hospital/ Organization: *
Business Address: *
Address 2:
City: *
State/Possession or Province: *
Zip: *
Country: *
Business Phone: *
(xxx) xxx-xxxx
Business Fax: *
(xxx) xxx-xxxx

Home Address Home Address: *
Address 2:
City: *
State/Possession or Province: *
Zip: *
Country: *
Home Phone: *
(xxx) xxx-xxxx
Primary Email Address: *
Secondary Email Address:

* Should SVS mail correspondence to your business or home address? Business: Home:

Select ONE of the following criteria below: Criterion 1: Training
Successful completion of an ACGME-approved or the Royal College of Physicians and Surgeons of Canada approved vascular surgery training, or their equivalent in the United States or Canada.
Criterion 2: Certification
Certification required in Vascular Surgery from the United States or Canada.
Criterion 3: Surgeons whose clinical practice is dedicated primarily to vascular surgery
The Membership Committee will take into account the following factors:

Contributions to vascular surgery education
Contributions to vascular surgery research
Membership in the American College of Surgeons
Participation in regional or local vascular societies

*Indicate date you started active practice after residency/fellowship training (month and year):

Criterion 1: Training

Successful completion of an ACGME-approved or the Royal College of Physicians and Surgeons of Canada approved vascular surgery training, or their equivalent in the United States or Canada.

*Please check the appropriate training completed (at least one must be selected below):

ACGME approved vascular surgery training program
Royal College of Physicians and Surgeons of Canada approved vascular surgery training
Other (equivalent training to above)

Type of Training:
Location :
Dates of Training (month and year):
Program Director:

*Letters of Support
Select ONE of the following and upload the appropriate documentation:

Just completing training or in practice for one year or less: A letter from your Program Director attesting to the successful completion of training must be included with the application.
You can upload letter (Word document or PDF) from your Program Director below or mail hard copy of letter to mailing address below.
Trained vascular surgeon in practice for one or more years: Letters of support from two (2) SVS members must be included with the application. When SVS members in the community are not available to provide letters of support, letters can be obtained from physicians in leadership positions at institutions where the applicant is a vascular surgeon.
You can upload two letters of support (Word document or PDF) below or mail hard copy of letter to mailing address below.

Name of Program Director: *

Select a file to upload:

Please Note: hardcopies of these letters may be mailed to:

SVS Membership Coordinator
Society for Vascular Surgery
633 N. Saint Clair Street, 24th floor
Chicago, IL 60611

Name of Sponsor 1: *

Select a file to upload:

Name of Sponsor 2: *

Select a file to upload:

Please Note: hardcopies of these letters may be mailed to:

SVS Membership Coordinator
Society for Vascular Surgery
633 N. Saint Clair Street, 24th floor
Chicago, IL 60611

Criterion 2: Certification

Certification required in Vascular Surgery from the United States or Canada.

*Letters of Support

Appropriate letters of support from two (2) SVS members are required. When SVS members in the community are not available to provide letters of support, letters can be obtained from physicians in leadership positions at institutions where the applicant is a vascular surgeon. Upload two letters of support (Word document of PDF) or mail hard copy of letters to mailing address below.

Name of Sponsor 1: *

Select a file to upload:

Name of Sponsor 2: *

Select a file to upload:

SVS Membership Coordinator
Society for Vascular Surgery
633 N. Saint Clair Street, 24th floor
Chicago, IL 60611

*Please check the appropriate certificate(s) and include certificate numbers (at least one certificate number must be provided below):

American Board of Surgery Certificate in Vascular Surgery
Certificate #:
Royal College Certificate of Special Competence in Vascular Surgery
Certificate #:

* Payment

Application Fee is $100 USD Non-Refundable.

Select Method of Payment:

Visa
MasterCard
American Express
Card number:
(No dashes or spaces)
Expiration Date (mm/yy):
Name As It Appears On Card:

Check made payable to the Society for Vascular Surgery. Mail check to SVS, 633 N. St. Clair, 24th Floor, Chicago, IL 60611. Your application will not be processed without receipt of payment.

Please click submit button only once.
Submission may take up to a minute depending on the size of the document attachments.

Society for Vascular Surgery - 633 N. St. Clair, 24th Floor; Chicago, IL 60611; Phone: 312-334-2300 or 800-258-7188; Fax: 312-334-2320; Email: vascular@vascularsociety.org
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