SBAS Institutional Membership Application – Society of Black Academic Surgeons

SBAS is grateful for our current Institutional Members.

Learn about the benefits of Institutional Membership!

SBAS Institutional Memberships run on a July – June timeline. Applications submitted will result in membership from July 1, 2026 – June 30, 2027. For questions, please contact us at Instmembership@sbas.net.

Institutional Member Application

Institutional Member Application Form

Institutional Membership Dues(Required)

Institutional – Platinum $5,000

Institutional – Gold $2,500

Institutional – Silver $1,000

Name(Required)

First Last

Department Chair(Required)

First Last

Institution Name(Required)

Institution Address Line 1(Required)

Institution Address Line 2

City(Required)

State/Province(Required)

Postal Code

Country

Preferred Email:(Required)

Preferred Contact Phone(Required)

Staff Contact Name

First Last

Staff Contact Email

Staff Contact Phone

High Resolution Logo

Max. file size: 512 MB.

Vector file type (AI, EPS, SVG)

Standard Logo

Max. file size: 512 MB.

JPEG, PNG

Payment Information

Payment Method(Required)

Credit Card

Check

Total

Credit Card