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Thank you for your interest in the CAG Fellow Designation. Please fill out the required application information below.

PLEASE ENSURE ALL ATTACHMENT FILE NAMES DO NOT CONTAIN SPECIAL CHARACTERS. This includes but is not limited to  ! * # ; ? \ / : " < > |.

PLEASE NOTE that you must submit the online application, in one single step; you are not able to save your application and return to it at a future date, rather it must be completed all at one time.

Applicant Details

 

Nominator(s) Information

 Note: Information required for at least (1) CAG Regular Member.

 

Nominator 1

Nominator 2

Undergraduate Details

 

 

Medical/Postgraduate Details

 

 

 

 

Internship Details

 

 

Residency Details

 

 

Fellowship Details

 

 

Hospital Appointment

 

 

Teaching Affiliations

 

 



 

 

Contribution to the CAG

Contribution to the CAG through committee or executive work with at least (5) years holding CAG positions. These years need not be consecutive.

 

 



 

 



 

 



 

 



 

 



CAG CME Participation

Evidence of participation in (as participant and/or faculty) a minimum of 3 CME programs sponsored by the CAG (includes CDDW™) within the last (5) years. Please list each "Role Type" separately for the same program.

 

 



 

 



 

 



 

 



 

 



Required Documentation

Note: Files must be in .pdf format.

Please click on the "Submit" button to submit your application for the CAG Fellow Designation. Before submitting, please ensure you have filled out all of the mandatory fields and all attachments are correct.

Upon successful submission you will be directed to a webpage that confirms the successful submission and within a short period of time you will receive an email from the CAG National Office confirming receipt of your submission.  If this does not occur, please contact the CAG National Office.

NOTE: Upon submission do not close your browser or use the back button until the Thank you screen appears confirming your submission has gone through. Uploading of large files may take a minute or so.