Application Form
The American Psychosomatic Society
Sponsorship of Psychosomatic Medicine Interest Groups
Fax: 703-556-8729; Email: info@psychosomatic.org
 
Name of medical school:
Faculty Sponsor
Address:
Phone:
Fax:
Email:
Proposed PMIG goals, target trainees, meeting plan, use of funds, and growth potential
(200 words or less):
 
Please tell us to whom the PMIG check should be made payable:
Address to where the PMIG check should be mailed:
 
The APS Past Leaders Committee is working with the Strategic Growth Subcommittee of APS and all schools receiving funding will be assigned a Past Leader to serve as a liaison. Please indicate your preferences for Past Leaders you would like to liaison with your interest group, should you be awarded funding:
 
First Choice:
Second Choice:
Third Choice:

Robert Ader, PhD, MD - Rochester, NY, USA
Robert Ader, PhD, MD - Rochester, NY, USA
Mike Antoni, PhD - Coral Gables, FL, USA
Arthur J.Barsky, MD - Boston, MA, USA
James A. Blumenthal, PhD - Durham , NC, USA
Dana H. Bovbjerg, PhD - Pittsburgh, PA USA
Oliver G. Cameron, MD, PhD - Ann Arbor, MI. USA
Edwin H. Cassem, MD - Boston, MA, USA
Stephanie Von Ammon Cavanaugh, MD - Chicago, IL, USA
Margaret A. Chesney, PhD - Baltimore, MD, USA
Steven Cole, MD - Stony Brook, NY, USA
Joel E. Dimsdale, MD - La Jolla, CA, USA
Douglas A. Drossman, MD - Chapel Hill, NC, USA
Jean Endicott, PhD - Bronx, NY, USA
Bernard T. Engel, PhD - Raleigh, NC, USA
Susan Everson-Rose, PhD - Minneapolis, MN USA
Ann Maxwell Eward, PhD - Niantic, CT, USA
Nancy Frasure-Smith, PhD - Montreal, Quebec, Canada
Stanford B. Friedman, MD - Hansville, WA, USA
Donna B. Greenberg, MD - Winchester, MA, USA
Sidney Hart, MD – Greenwich, CT, USA
Christoph Herrmann-Lingen, MD - Gottingen, Germany
Jules Hirsch, MD - New York, NY, USA
Myron A. Hofer, MD - New York, NY, USA
Gail Ironson, MD, PhD - Miami, FL, USA
Jane Irvine, PhD - Toronto, Ontario, Canada
Michael R. Irwin, MD - Los Angeles, CA, USA
J. Richard Jennings, PhD - Pittsburgh, PA, USA
Wayne Jay Katon, MD - Seattle, WA, USA
Francis Keefe, PhD - Durham, NC, USA,
Donald S. Kornfeld, MD - Tenafly, NJ USA
David S. Krantz, PhD - Bethesda, MD, USA
David J. Kupfer, MD - Pittsburgh, PA, USA
Richard D. Lane, MD, PhD - Tucson, AZ, USA

Jane Leserman, PhD - Chapel Hill, NC, USA
Francois Lespérance, MD - Montreal, Quebec, Canada
Susan B. Levenstein, MD - Rome, Italy
Norman B. Levy, MD – Beverly Hills, CA, USA
Kathleen C. Light, PhD – Salt Lake City, UT USA
Don R. Lipsitt, MD - Brookline, MA, USA
Steven E. Locke, MD - Wayland, MA, USA
William R. Lovallo, PhD - Oklahoma City, OK, USA
Mark A. Lumley, PhD - Detroit, MI, USA
Susan K. Lutgendorf - PhD, Iowa City, IA, USA
John W. Mason, MD - Woodbridge, CT, USA
Karen A. Matthews, PhD - Pittsburgh, PA, USA
Matthew F. Muldoon, MD, MPH - Pittsburgh, PA, USA
Dennis H. Novack, MD - Philadelphia, PA, USA
Herbert N. Ochitill, MD - San Francisco, CA, USA
Donald Oken, MD - Haverford, PA, USA
Kristina Orth-Gomér, MD - Stockholm, Sweden
Lynda H. Powell, PhD - Chicago, IL , USA
Richard H. Rahe, MD - Salem, OR USA
Bruce L. Rollman , MD - Pittsburgh, PA, USA
Carolyn E. Schwartz, ScD - Concord, MA, USA
Peter A. Shapiro, MD - New York, NY, USA
Peter M. Silberfarb, MD - Lebanon, NH, USA
Richard P. Sloan, PhD - New York, NY, USA
Timothy W. Smith, PhD - Salt Lake City, UT, USA
Marvin Stein, MD - Riverdale, NY, USA
Arthur A. Stone, PhD - Stony Brook, NY, USA
Albert J. Stunkard, MD - Philadelphia, PA, USA
Julian F. Thayer, PhD - Columbus, OH, USA
Shari R. Waldstein, PhD - Baltimore, MD, USA
Redford B. Williams, MD - Durham, NC, USA
Thomas N. Wise, MD - Falls Church,VA, USA
Michael Ziegler, MD - San Diego, CA, USA