Application for Board Certification

Please review the Eligibility Requirements prior to submitting the application. You will be able to upload your CV/Resume file on Step 2 of the application.

Application Type

Application Type:

Your Email:

Application Fee:

$475 for Private Practice Physicians
$375 for Academic Physicians and Scientists

I understand that I must remain an active member in good standing with the ASRM to maintain my Board Certification.

I have reviewed all eligibility requirements and understand that my application may be denied by the AABRM Board of Directors

Your Details

First Name:

Last Name:

Company Name:

Phone:

Address:

City:

State:

Postal Code:

Country:

I would like to receive e-mail updates from AABRM:

Physician Application Information

Active Member:

Active Membership Required to Apply

I have at least 12 months of experience in the specialty of Regenerative Medicine

Percentage of Practice/Research dedicated to Regenerative Medicine (min. 10% required):

Degree:

Practice Name:

Primary Specialty:

Primary Board Certification:

State License Number/State:

Have you ever been asked to surrended your license to practice?

Have you had a malpractice suit in the last 5 years, where damages were paid out?

If 'yes': please provide a written statement regarding the circumstances and outcome:

Payment Information

Name on Card:

Card Type:

Credit Card Number:

Expires (MM/YY):

CVV Code: