Fellow Membership Application

Once you have completed an AENS Fundamental Course or equivalent you will be listed as a Fellow Qualified member and will have up to 5 years to provide the remaining criteria.

  1. Member in good standing who has completed either the Dellon Institute or the AENS equivalent Fundamental Workshop, or physicians can petition the AENS Membership Committee and Executive Officers for comparable training waiver status. If attended AENS meetings/trainings. 
  2. Hold a DPM, MD, DO degree.
  3. Have documented evidence of accomplishments in peripheral nerve surgery or research submitted to AENS within 3 years of Fellow status.
         *Submit copy of lecture and program you provided on nerve treatment, or copy of abstract, posters, articles or research protocols in which you have participated. Any items that you have participated in to advance or promote nerve treatment will be considered.
  4. Should demonstrate evidence of continuing study and/or research in the assessment and treatment of peripheral nerve conditions
          *Submit copy of attendance certificate for related courses or meetings, or submit copy of abstract, poster, article published or participation of research distributed.
  5. Must provide case logs consisting of 200 peripheral nerve procedures within past 5 years demonstrating treatment of a broad spectrum of peripheral nerve conditions (neurolyses, denervation/implantation, nerve repair, etc…). You may submit op report summaries or a case log spreadsheet, but they must include at minimum: dates of sx, list of procedures performed, hospital name and that you performed them.
         *The completion of each of the AENS Fundamental Course, Advanced Course and/or approved Microsurgical Course will meet 20 procedures toward this requirement.
  6. DPM Fellows must be members in good standing with the American Podiatric Medical Association.
  7. Rights and Duties:
    • Fellows may vote, hold office, and are expected to serve on committees of the AENS
    • To be considered a Fellow of the AENS, members must remain in good standing with the Association including the payment of dues and attendance at continuing medical education meetings.
    • A Member may be "Fellow Qualified" for up to 5 years with all privileges, until all criteria is met, at that point, membership can be altered to Associate.

By checking the box below, I authorize the above requirements to become an AENS Fellow. I am verifying that all 200 procedures submitted were performed by me. I also understand and agree that if I am approved as an AENS Fellow, I will follow all ethical guidelines that apply to patient care and physician scope of practice. I cannot reproduce AENS training or educational materials without the express written consent from the Association.

Required field(s) are indicated by an *.
 
* Completion of Fundamental Nerve Course / / (MM/DD/YYYY)
Please upload the supporting documentation using the Browse buttons below. NOTE: each file upload is limited to 25 MB in size, if you need to upload the procedures list larger than 25 MB please split it in two separate files.
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