Application

Application

The Bylaws of the Texas Spine Society establish membership criteria as follows:

Resident of Texas;

Board Certified in orthopedic surgery or neurosurgery;

Member, in good standing, of the American of Orthopaedic Surgeons or the American Association of Neurological Surgeons;

Medical practice at least 75% of which is related to care and treatment of the spine and/or spinal disorders;

Has completed a spine fellowship if in practice 5 years or less. If in practice more than 5 years and has not completed a spins fellowship, acceptance is at the discretion of the members;

Provided to Board of Directors of the Society letters of recommendation from two currently active members of the society;

Received a confirmation vote of two-thirds of the members present at the annual meeting at which all other criteria for membership have been satisfied.

MEMBERSHIP APPLICATION

APPLICANT NAME

ADDRESS

CITY ZIP CODE

PHONE FAX

Email Address

I certify that I meet the following criteria for membership in the Texas Spine Society:

(1) I am board certified in orthopaedic surgery or neurosurgery; Year

(2) I am a member in good standing with the American Academy of Orthopaedic Surgeons or American Association of Neurological Surgeons: year of admission

(3) At least 75% of my practice is devoted to treatment of the spine;

(4) I was recommended for Texas Spine Society membership by the following two (2) members;

(5) I have completed a Spine Fellowship:

Location

Dates

If accepted for membership in the Texas Spine Society, I agree to abide by the Society's by-laws.

SIGNATURE DATE

Revised: Monday, April 04, 2005 09:33 AM