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Membership Application

Full name (Dr. First Last, if applicable)

Phone number

City, State (United States); City, Country (International)

Undergraduate College/University

Credentials ("Student" if applicable)

Residency program

Medical/Allied Sciences School

Professional title

Fellowship program

Other post-graduate training

Current employer/institution

Years in independent practice

Retired

Describe any clinical, surgical, research, or educational experience involving limb preservation, reconstruction, or complex wound care.

Research involvement

PubMed/ResearchGate/Google Scholar Link

List any awards, scholarships, honors, or notable recognitions you have received.

CV (pdf)

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Professional Headshot

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I agree to share my email and phone number with the Orthoplastic Limb Preservation Society to receive information about OLPS, and for delivery of any incentives to which I qualify.

Signature

Orthoplastic Limb Preservation Society
& World Orthoplastic Society

Ορθοπλαστική Κοινωνία Διατήρησης Άκρου MMXXV

Membership Application