Membership Application

The Rhinoplasty Society Membership Application for –
Active, Associate and Corresponding Categories

Membership Requirements

Active Membership – For those board certified rhinoplasty surgeons in active practice a minimum of 3 years.

CLICK HERE for further Active member requirements.

Active Membership shall be limited to those surgeons who fulfill the following requirements:

  1. Persons who perform plastic surgery or facial plastic surgery and who are board certified by the American Board of Plastic Surgery, the American Board of Facial Plastic and Reconstructive surgery, the American Board of Otolaryngology, or an equivalent foreign examining board are eligible for membership in The Rhinoplasty Society.
  2. Three years’ active practice in the field of Plastic and Reconstructive Surgery, Facial Plastic and Reconstructive Surgery or Otolaryngology/ENT.
  3. Profound interest in rhinoplasty and aesthetic surgery as documented to the satisfaction of the Membership Committee by the publication of articles in peer reviewed journals as lead author, text book chapters, or the teaching of rhinoplasty courses. Members in this category are expected to have made contributions that further the field of rhinoplasty. Under some circumstances, and at the recommendation of the Membership Committee, applicants may be recommended for Active Membership based on exceptional merit as demonstrated by contributions to teaching, writing and Society contributions in aesthetic surgery.
  4. Recent 24-month rhinoplasty operative log supporting experience in rhinoplasty, averaging at least thirty (30) cases per year.
  5. Sponsorship by two Active Members.
  6. Attendance at an Annual Meeting of The Rhinoplasty Society within the previous three (3) years, to include the meeting of the applicant vote.

Associate Membership – For those board certified rhinoplasty surgeons in active practice a minimum of 3 years, who do not meet all criteria for Active member.

CLICK HERE for further Associate member requirements.

Associate membership will apply to rhinoplasty surgeons who satisfy the following requirement:

  1. Persons who perform plastic surgery or facial plastic surgery and who are board certified by the American Board of Plastic Surgery, the American Board of Facial Plastic and Reconstructive surgery, the American Board of Otolaryngology or an equivalent foreign examining board are eligible for membership in The Rhinoplasty Society.
  2. Three years’ active practice in the field of Plastic and Reconstructive Surgery, Facial Plastic and Reconstructive Surgery, or Otolaryngology/ENT.
  3. Sponsorship by two Active Members.
  4. Recent 24-month rhinoplasty operative log supporting experience in rhinoplasty, averaging less than thirty (30) cases per year.
  5. Attendance at an Annual Meeting of The Rhinoplasty Society within the previous three (3) years, to include the meeting of the applicant vote.

Corresponding Membership – For those International surgeons in active practice a minimum of 3 years, who do not have 2 Active member sponsors

please CLICK HERE for further Corresponding member requirements.

Corresponding membership will apply to international rhinoplasty surgeons who satisfy the following requirements:

  1. Persons who perform plastic surgery or facial plastic surgery and who are Board Certified equivalent in Plastic Surgery, Facial Plastic Surgery, Otolaryngology, or ENT through an international examining board are eligible for Corresponding membership with The Rhinoplasty Society.
  2. Three years’ experience in the field of plastic and reconstructive surgery, facial plastic and reconstructive surgery or otolaryngology/ENT.
  3. Recent 24-month rhinoplasty operative log supporting experience in rhinoplasty.
  4. Proof of membership in good standing with ASPS, ASAPS, ISPS, ISAPS or equivalent for Otolaryngology/ENT trained surgeons.

Please note: The required documents below must be uploaded with application.

  1. Full CV
  2. Rhinoplasty Surgery Log – excel file listing patient ID (not name – can be patient number or initials), date of surgery, title of surgery for the most recent 24 months.
  3. Summary sheet – (download link) for the same 24-month period as surgery log.
  4. Copy of Active Membership Certificate from one of the following:
    • ASPS membership
    • AAFPRS membership
    • AAOHNS membership
    • Equivalent foreign national society
    • Corresponding applicants must show proof of membership with one of the following: ASPS, ISPS, ISAPS or equivalent for OTO/ENT trained surgeons.

APPLICATION DEADLINE

All application materials must be received by the Executive Office by December 31, for the applicant to be considered for admission to membership at the Annual Meeting in the spring of the following year. If you have not previously attended an Annual Meeting, you must attend the meeting when your application is up for vote by the membership.

Failure to attend will not stop the vote; however, your membership will not go into effect until such time that you do attend an annual meeting. Please contact Jeanie Hodges in the Society Office with any questions at 904-786-1377.

MEMBERSHIP APPLICATION PROCEDURE

PLEASE NOTE: All required documents must be uploaded with application. Unfinished application cannot be saved.

Required Uploads* Please keep each upload under 10 MB in size and note the acceptable formats:

Curriculum Vitae (doc, docx, pdf):

Surgery Log (xls/xlsx):

Summary sheet (xls/xlsx):

Copy of membership certificate (jpg, jpeg, gif, png, pdf):


Application is for:

Active MembershipAssociate MembershipCorresponding Membership


Personal Information

Name (required)

Date of Birth:

Birthplace:

BUSINESS INFORMATION

Office Address:

City:

Country:

Province / State:

Zip:

Telephone:

Fax:

Email Address (required):

Web Address:

EDUCATION

Undergraduate College:

Degree/Year:

Medical School:

Degree/Year:

Other Graduate School:

Degree/Year:

GRADUATE MEDICAL TRAININGS

Surgical Residency (Speciality, i.e. general, ENT, orthopedic):

Plastic Surgery Residencies, Preceptorships, Fellowships:

LICENSURE

Licensure State:


License Country:

License Number:

License Year:

CERTIFICATION

Certification by ABMS Specialty Board (or the foreign equivalent) and Dates:

OTHER INFORMATION

Hospital Affiliations/ Medical School Appointments and Dates:

Honors, Fellowships, Research, and Grants:

Rhinoplasty Lectureships/ Instructional, Postgraduate, Masters, Rhinoplasty Courses Taught:

Professional Society Memberships:

Committee Responsibilities, Offices held in Professional Societies:

PRIOR RHINOPLASTY SOCIETY ANNUAL MEETING ATTENDANCE

Location of Rhinoplasty Society Annual Meeting attended:

Year:

GENERAL QUESTIONS

Has membership in any medical society ever been denied, suspended, or revoked? (if yes, please give details below):
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Have hospital privileges ever been denied, suspended, or revoked, or have you ever been placed on probation? (if yes, please give details below):

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Have you ever had your medical license or narcotics license suspended or revoked, or have you been placed on probation by a licensing authority for any reason, including drugs or alcohol? (if yes, please give details below):

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Are you currently under investigation by the ethics or judiciary committee of any medical society? (if yes, please give details below):

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Have you ever been named a defendant in malpractice actions, past or pending? (if yes, please give details below):
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SPONSORS

Sponsor 1:

Sponsor 2:

$250 Application Fee Paid By:

Paying OnlineWill send check

your application before proceeding to application fee payment. Then proceed to payment below:

To pay by credit card CLICK HERE

Or

Send check made out to The Rhinoplasty Society to:
P.O. Box 441745, Jacksonville, FL 32222-0018
(Please note your application will not be processed until application fee has been received)