Apply to Join ASMBS Committees

Use this form to share your interest in becoming involved with the many ASMBS committees. Once you complete this form you will be entered into the ASMBS database and will be contacted when committee positions become available. To learn more about the ASMBS Committees click here.

• Name
  First Last
• Member Number
• Email*
• Start Date (optional)
  MM slash DD slash YYYY
• First Preference*
  Select one...Bariatric Surgery TrainingClinical IssuesCommunicationsCommunity/Independent PracticeDiversity & InclusionEmerging Technologies & ProceduresFlexible EndoscopyGeneral and Foregut SurgeryInsuranceInternational DevelopmentMembershipMilitaryPOWER TaskforceQuality Improvement and Patient SafetyPediatric SurgeryPublic EducationResearchRuralVideo/Archive on Audio-Visual HistoryIH Advanced Practice ProviderIH CBN CertificationIH Clinical IssuesIH CommunicationsIH MembershipIH Multidisciplinary CareIH Professional EducationIH Support Group
• Second Preference*
  Select one...Bariatric Surgery TrainingClinical IssuesCommunicationsCommunity/Independent PracticeDiversity & InclusionEmerging Technologies & ProceduresFlexible EndoscopyGeneral and Foregut SurgeryInsuranceInternational DevelopmentMembershipMilitaryPOWER TaskforceQuality Improvement and Patient SafetyPediatric SurgeryPublic EducationResearchRuralVideo/Archive on Audio-Visual HistoryIH Advanced Practice ProviderIH CBN CertificationIH Clinical IssuesIH CommunicationsIH MembershipIH Multidisciplinary CareIH Professional EducationIH Support Group
• Third Preference*
  Select one...Bariatric Surgery TrainingClinical IssuesCommunicationsCommunity/Independent PracticeDiversity & InclusionEmerging Technologies & ProceduresFlexible EndoscopyGeneral and Foregut SurgeryInsuranceInternational DevelopmentMembershipMilitaryPOWER TaskforceQuality Improvement and Patient SafetyPediatric SurgeryPublic EducationResearchRuralVideo/Archive on Audio-Visual HistoryIH Advanced Practice ProviderIH CBN CertificationIH Clinical IssuesIH CommunicationsIH MembershipIH Multidisciplinary CareIH Professional EducationIH Support Group
  Please note that the Access to Care, Program, and State and Local Chapters Committees are not accepting applications at this time. Committee membership is currently by appointment only.
• Background and Experience*
  • Upload your Resume or CV
  • Submit your Bio
  Select an option to share your background and experience.
• Upload your Resume or CV*
  Accepted file types: doc, docx, txt, rtf, pdf, Max. file size: 16 MB.
  File must be doc, docx, txt, rtf, or pdf
• Your Bio*
  Maximum 1,000 characters
• Comments (optional)
• Are you an ASMBS Member?*
  • Yes
  • No
• Join ASMBS to get involved. Click here for details. Only ASMBS members can join committees. If you submit this form and are not an active ASMBS member, someone will contact you about joining.
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