Lineage Form

In an effort to encourage continued growth of the academy membership from within our own ranks, we ask that you fill out your best recollection of your own personal lineage in the NYAD with regard to who proposed you for membership and perhaps who seconded the proposal (if you recall). Additionally, please include the doctors that you have proposed in the past who have become members. This information will be compiled by the Subcommittee to create a framework for future membership nominations within each lineage.  We envision members of each lineage (including crossover lineages) to meet either in person, over the phone via conference call, or via email to come up with “organic” proposals.  Each lineage can then assign who the “proposer” and who the “seconder” should be.  Please note that it is permitted to propose multiple candidates for membership.  Admissions are rolling—there is no deadline for submission.

If you have any comments or questions, please contact:


Mark J. Bronsky  (; (212)-758-0040)

Caryn M. Siegel  (; (212)-369-2213)

Stacy Spizuoco   (; (212)-688-1090)

Please return this form via email to:

Mark J. Bronsky: