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University / Affiliations
Graduated School of Medicine / Faculty
If you are a fellow/resident, in what year will you seize to be a one? e.g. 2023 or NA
Memberships in Other Medical / Surgical Organizations (Please write "none" if there isn't any)
Published Contributions to Medical Literature in the last 5 years (Please write "none" if there isn't any)
How would you like your name to appear on your membership certificate?
Would you like to be considered for a position on a ISUCRS committee? See by-laws for more information
No
Committee on Future Meeting Places
Committee on Bylaws
Membership Committee
Publication Committee
Education Committee
Program Committee
Future Planning Committee
Grant Committee
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