IAAPS Application Form.pdf

7/28/2019 IAAPS Application Form.pdf

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INDIAN ASSOCIATION OF AESTHETIC PLASTIC SURGEONS(Registration No. S - 28468 of 1995 at New Delhi)

APPLICATION FORM FOR MEMBERSHIP

1. NAME. . .

2. AGE . Yrs. Date of Birth. SEX: M / FDate of Marriage. .

3. ADDRESS : Clinic / Office Residence.

. . . .

. . . .

CITY . ___. Pin CITY . __________ . Pin.

STATE . . COUNTRY . . STATE . . COUNTRY . .

PHONE: PHONE:

E-mail ID:

4. ACADEMIC QUALIFICATIONS: *

DEGREE INSTITUTION YEAR OF PASSING

5. TRAINING: * INSTITUTION DURATION & DATES

a. Basic Plastic Surgery:

b. Aesthetic Plastic Surgery:

6. TEACHING EXPERIENCE: * INSTITUTION DURATION & DATES

a. Undergraduate :

b. Postgraduate :

CONT. > page 2

PLEASE PASTE

RECENT PASSPORT

SIZE PHOTOGRAPH

AND SIGN OVER IT



2

7. EXPERIENCE IN AESTHETIC PLASTIC SURGERY; Yrs.

8. WORK IN AESTHETIC PLASTIC SURGERY AS PERCENTAGE OF TOTAL WORK IN PLASTIC SURGERY: %

9. PUBLICATIONS ON AESTHETIC PLASTIC SURGERY IN INDEXED / NON INDEXED JOURNALS.

10. PAPERS PRESENTED ON AESTHETIC PLASTIC SURGERY IN CONFERENCES.

11. MEMBERSHIPS / FELLOWSHIPS

ASSOCIATION FULL / ASSO. LIFE/ ANNUAL REG. NUMBERS.

A.S.I.

A.P.S.I.

OTHERS:

DECLARATION:-I here by declare that the information given above is true. I have furnished requisite proof as and where desired. I take oath toabide to the constitution and by-laws of the “Indian Association of Aesthetic Plastic Surgeons” (I A A P S).

Signature of the applicant

PROPOSED BY SECONDED BY

* Kindly attach photocopies of certificates to authenticate your statement .

Column 4, 5, 6, 9, 10 & 11, use separate sheet if given space is inadequate.



Rules and regulations for Full / Life membership:

1. The candidate should be in possession of recognized degree / training in basic Plastic surgery.

2. Should have training in Aesthetic Plastic surgery / have recognized work in the field of Aesthetic Plastic Surgery / presentations and or publications / other academic contributions in the field of Aesthetic Plastic Surgery.

3. Should be a member of A P S I (Association of Plastic Surgeons of India).

4. The candidate should be proposed and seconded by full / life members of the I A A P S (Indian Association of Aesthetic Plastic Surgeons).

5. The executive body of the I A A P S, shall process the application and notify the decision to the applicant.

6. Membership Fee;

Life Member Rs. 10000/-

Honorary Member – People of outstanding contributions to Aesthetic

Surgery will be selected as honorary members by the executive andapproved by the general body. They will not be able to participate in

elections and will not be able to hold any office.

7 Please send a Draft of Rs. 10000/- in the name of ” IAAPS” payable at New Delhi, along with the application asLife membership fee... All the applications are put-up to the credentials committee for approval, which normally meets

once every year.

Kindly send the completed membership form to: -

Secretariat:

Dr Anup Dhir 101 ANSAL TOWER, 38 NEHRU PLACE

NEW DELHI 110019 INDIA

TEL +91-11-26438044, +91-9312377554

e-mail [email protected]

mailto:[email protected]



Documents

IAAPS Application Form.pdf