Application for Membership in the Society

Candidates may apply for membership to the society from various subspecialties of medicine including but not exclusive to Otolaryngology-Head & Neck Surgery, General Surgery, Oral & Maxillofacial Surgery, Plastic & Reconstructive Surgery, Prosthedontics, Medical Oncology, Radiation Oncology, Radiology, Nuclear Medicine, Head & Neck Pathology and other disciplines which actively deal with the management of Head & Neck Tumors.

Specific requirements for membership depend on the specialty. For example, surgical candidates for active membership shall furnish proof of ability to perform major head and neck surgery (by record of his or her past surgical training and by a statement of surgical experience within the preceding 12 months documenting numbers and distribution of procedures performed subsequent to completion of formal surgical residency training, completion of at least one year fellowship in head and neck surgery in addition to residency in general surgery, otolaryngology, or plastic surgery, or 35 major cases over a three year period, or 20 cases during one year.

Major cases should be defined as those resulting in removal of significant tumors of the head and neck region excluding skin. Plastic & Reconstructive Surgeons shall be required to have performed at least 20 major cases during a three year period or 10 major cases in one year. Medical Oncologists and Radiation Therapists shall be required to provide a case list showing a significant involvement in treatment of 35 patients during three years or 20 patients during one year for head and neck tumors. Other Physicians (diagnostic radiology, pathology, etc.) shall demonstrate significant involvement and/or accomplishment in the treatment and diagnosis of head and neck cancer by written description. Oral Surgeons and prosthodontists shall demonstrate significant ongoing involvement in the reconstruction and rehabilitation of patients with head and neck tumors. A bibliography including at least one paper on head and neck cancer is desirable.

The annual membership dues are $300 for active members and subject to change with notice. Active members of the society are expected to pay annual dues on a timely basis. The dues also cover the costs of the three pre-meeting dinners per year. Late dues paid after February 1st will be $325. Only “Senior Members” of the society are exempt from paying the annual dues. All scientific sessions are free and open to the general medical community, space permitting.

The application form may be downloaded from this Web site in either Microsoft Word or Adobe PDF format. Completed applications accompanied by case lists and letters of support must be mailed to the appropriate Executive Committee members:

Application submissions should be sent to:

Erik Cohen, MD
100 Madison Ave., First floor
Morristown, NJ 07960
erik.cohen@atlantichealth.org

All applications will be given fair and serious consideration based on merit and appropriateness as governed by the by-laws of the society.