AASM Fellow Membership Application
To be considered for fellow membership, please complete this form and submit it, along with the
required attachments to AASMmembership@aasmnet.org
Name: Click here to enter text.
Member Number: Click here to enter text.
Requirement 1: Be certified in sleep medicine by an American Board of Medical
Specialties (ABMS) member board or an American Osteopathic Association (AOA)
specialty certifying board OR certified in Behavioral Sleep Medicine by the ABSM.
Which board certified you in sleep medicine? (Check One)
ABMS Member Boards
☐ABIM
☐ABPN
☐ABP (Pediatrics)
☐ABOto
☐ABA (Anesthesiology)
☐ABFM
AOA Specialty Certifying Board
☐Family Physicians
☐Internal Medicine
☐Neurology and Psychiatry
☐Ophthalmology and Otolaryngology
Office
Use Only
☐
☐American Board of Sleep Medicine (in behavioral sleep medicine)
Requirement 2: Hold membership in the AASM Regular category for the last five
consecutive years.
What year did you join the AASM? Click here to enter text.
☐
Requirement 3: Demonstrate special contributions to scientific literature or significant
advancements in the field of sleep medicine in at least two of the following three
areas: Research, Service, or Education.
☐
Research: Describe below contributions to scientific literature or significant
advancements in the field of sleep medicine. Contributions should be referenced.
Click here to enter text.
Service: Describe below participation in the practice of sleep medicine with proven
leadership within the community relating to the advancement of sleep medicine. This
can include activities within the AASM or leadership at a local or regional level.
Click here to enter text.
Education: Describe below dedication to the advancement of the field of sleep
medicine through teaching, which may include the development of courses, training of
medical students, residents and fellows, or provision of continuing medical educations
in sleep medicine.
2510 North Frontage Rd., Darien, IL 60561
Office: 630/737-9700, Fax: 630/737-9790, Email: aasm@aasmnet.org
www.aasmnet.org
Click here to enter text.
Required Attachments:
☐ Documentation of current certification by ABMS member board, AOA specialty certifying
board, or ABSM (certified in Behavioral Sleep Medicine)
☐ Curriculum Vitae
☐ Letter of recommendation from someone board certified in sleep medicine by the ABSM, an
ABMS member board, or AOA specialty certifying board describing the nominee’s achievements
in at least two of the three above- noted areas
☐ Letter of support from an independent medical professional outside the group or department of
the nominee
2510 North Frontage Rd., Darien, IL 60561
Office: 630/737-9700, Fax: 630/737-9790, Email: aasm@aasmnet.org
www.aasmnet.org