SAAOG Membership Application

The first step in the SAAOG application process is to submit an application form, CV, letter of recommendation from a current member, and dues payment. The application will be processed by staff, and then sent to the SAAOG membership in your state for review. Once the application has been reviewed by state members, it will be sent to the Secretary and appropriate State Representatives for review. Once approved, the candidate will be considered provisionally approved until a formal approval takes place at the next board meeting.

Type of Membership

Type	Fee
Active Member - Individual active in OB/GYN practice 65 and under	$435.00
Senior Member - Individual active in OB/GYN practice 66 and over	$217.50
Associate Member - Individual who has moved outside of the SAAOG Region	$75.00
Retired Member - Individual who is retired from OB/GYN practice	$150.00
Introductory Member - Individual active in OB/GYN practice who qualifies as an Active Member but are new to SAAOG Membership (good for two years before transitioning to Active Member)	$217.50
Physician-in-Training Member* - Individual in-training and not yet ABOG certified	$0.00
Medical Student Member* - Individual actively enrolled in medical school	$0.00

A Letter of Recommendation from a Current SAAOG Member is required at time of application.
*Physician-in-Training and Medical Student Applicants must submit a letter of recommendation from their Program Director.
Please email Shana Harvey at sharvey@saaog.org with questions.

Member Profile

First Name*

Middle Name

Last Name*

Primary Degree

Gender*

Prefered Email*

Work Phone

Cell Phone*

Preferred Phone* Cell Phone Work Phone

Date of Birth

Job Title

Specialty

ACOG Member #

License Number

License Year

Practice Type

Academic

Group Practice

Hospital

Military

Other

By joining SAAOG, you agree to opt-in to receive all phone, fax, email, and other electronic communications sent by SAAOG. To opt out of receiving these communications, please check the box.

Mailing Information

Choose mailing preference

Choose fax preference

Office Address

Organization

Street Line 1

Street Line 2

City

State

Zip/Postal Code

Phone

Fax

Home Address

Street Line 1

Street Line 2

City

State

Zip/Postal Code

Phone

Fax

Education History

Medical/Graduate

Location

Year

Degree

Residency (Postgraduate Training)

Location

Year

Degree

Fellowship (Postgraduate Training)

Location

Year

Degree

Administrative Contact Person

If you have a support person who the Society may contact when you are busy, please provide his/her information.

Assistant's Name

Assistant's Email

Assistant's Phone Number

Document

CV (Required)

Accepted file types: PDF DOC DOCX

Letter of Recommendation From a Current Member (Required)

Accepted file types: PDF DOC DOCX

Referral Information

How did you hear about SAAOG?

Why are you joining?

Payment Information

First Name*

Last Name*

Zipcode*

Card Number*

Card Type

Expiration Month*

Expiration Year*

CVC Code*

Publication Date:

Thursday, February 15, 2018 - 10:00

Category:

Organization

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SAAOG Membership Application

Type of Membership

Member Profile

Mailing Information

Office Address

Home Address

Education History

Administrative Contact Person

Document

Referral Information

Payment Information