!!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA! ! !!!!!!!!!!!!!!!!!!!!!!!!!! Campagna di associazione SICPRE/ASPS !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!( Codice della Campagna: N° 279 ) !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ! Attenzione:! La campagna associativa promozionale prevede, per il potenziale socio, il risparmio della quota amministrativa una tantum di $ 125, aderendo egli/ella a questa campagna, entro il 15 settembre 2014. Le date chiavi per il socio SICPRE saranno, quest’anno: 17 Gennaio 2014 – I documenti richiesti dovranno pervenire all’ ASPS non oltre tale data: la richiesta di associazione sara’ sottoposta a voto e giudizio dell’assemblea del CD dell’ASPS del 28 Marzo 2014. 7 Aprile 2014 – I documenti richiesti dovranno pervenire all’ ASPS non oltre tale data: la richiesta di associazione sara’ sottoposta a voto e giudizio dell’assemblea del CD dell’ASPS stabilita per inizio luglio 2014. 1! Sede Legale / Segreteria : Via Costantino Morin, 45 – 00195 ROMA e.mail: [email protected] – sito: www.sicpre.it ! !!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA! La quota associativa annuale per l’ International Member e’ di $ 425 ed essa sara’ versata una volta ottenuto il membership. I soci che otterranno il membership alle votazioni di Marzo-Luglio ( quindi per le richieste partite a Gennaio od Aprile ) pagheranno una quota associativa relativa ai soli mesi residui dell’anno; i soci che otterranno il membership in occasione di The meeting di Ottobre, saranno da quel momento gia’ considerati soci a tutti gli effetti ma non pagheranno la quota associativa dell’anno corrente bensi’ la stessa sara’ versata per il successivo, entro il 1 gennaio 2015. !! ! !! 2! Sede Legale / Segreteria : Via Costantino Morin, 45 – 00195 ROMA e.mail: [email protected] – sito: www.sicpre.it ! !!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA! Il Socio Ordinario SICPRE che fara’ richiesta di associazione all’ ASPS dovra’ : a) Riempire il modulo ASPS cartaceo (allegato al presente documento) oppure “on line“ sul sito ASPS con i propri dati anagrafici e biografici, corredandolo di una propria fotografia standard da documento di riconoscimento. b) Produrre una lettera di referenze redatta dagli organi preposti SICPRE che attesti il suo status di socio ordinario, regolarita’ di iscrizione alla Societa’ ed i suoi elevati standard etici e professionali ,da richiedere al: [email protected]!!; c) Nel corso di questa campagna promozionale associativa, inserire nel modulo ASPS il codice 279 per ottenere l’esenzione dai diritti amministrativi; allo scadere di questa campagna promozionale e cioe’ oltre il 15 Settembre 2014, il socio dovra’ allegare la ricevuta di avvenuto pagamento degli oneri convenuti una tantum di $ 125. d) Inviare tutta la suddetta documentazione via email alla SICPRE : [email protected] Ricordiamo: Avendo la SICPRE sottoscritto il MoU, viene riconosciuta come unica Societa’ Ufficiale Italiana e l’unica che dia accesso a qualsiasi Specialista in Chirurgia Plastica italiano al Membership con ASPS: quindi il medico specialista in chirurgia plastica che richiede il membership all’ASPS dovra’ essere obbligatoriamente un membro SICPRE in regola con l’iscrizione e dovra’ presentare una lettera di referenze, firmata dal Presidente della 3! Sede Legale / Segreteria : Via Costantino Morin, 45 – 00195 ROMA e.mail: [email protected] – sito: www.sicpre.it ! !!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA! SICPRE, che attesti la regolarita’ dell’iscrizione, la data di quando si sia acquisito la qualifica di Socio Ordinario ed i suoi elevati standard etici e professionali. Benefici generali dell’ International Membership: 1) Abbonamento on line a PRS Journal 2) Abbonamento on line a PSNews 3) Sconto riservato su programmi ASPS, prodotti e servizi 4) Sconto su materiale educativo riservato ai pazienti 5) Collocazione nell’elenco on line dei Soci Internazionali ASPS presente sul web site ASPS 6) Nome ed indirizzo inseriti nella lista del web site ASPS: www.plasticsurgery.org 7) Accesso esclusivo dedicato ai Soci sul web site ASPS con tutto il materiale scientifico e promozionale allegato. 8) Verifica e gestione dei propri CME on line ( ricordiamo che dal 2011 grazie all’accordo tra EACCME e AMA c’e’ il riconoscimento dei CME acquisiti da un medico, negli Stati Uniti e cio’ e’ retroattivo al 2000 ) 9) Resident Education Center on Plastic Surgery Education Network (PSEN): fruibile on line tramite sito web con chiavi di accesso personali. Il PSEN dispensa una vasto numero di attivita’ di apprendimento 4! Sede Legale / Segreteria : Via Costantino Morin, 45 – 00195 ROMA e.mail: [email protected] – sito: www.sicpre.it ! !!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA! multimediali delle quali il Socio potra’ usufruire con tempi e modalita’ preferiti. Tali risorse saranno prezioso supporto per tutti i Soci che aderiranno al programma e per tutta la durata della loro vita lavorativa, dalla specializzazione alla pensione, fornendo essi l’ opportunita’ di un continuo aggiornamento professionale. 10) Sconto dedicato agli International Member, sulla quota d’iscrizione al congresso annuale ASPS “ The Meeting “. Se si e’ specialisti in Chirurgia Plastica da meno di 3 anni, si diventera’ : ASPS International Candidate, in attesa di maturare le credenziali per diventare un ASPS International Member . Per qualsiasi supporto logistico potete contattarmi scrivendo a: [email protected] Stefania de Fazio Consigliere SICPRE ASPS/MoU Representative 5! Sede Legale / Segreteria : Via Costantino Morin, 45 – 00195 ROMA e.mail: [email protected] – sito: www.sicpre.it ! Membership Advantage AMERICAN SOCIETY OF PLASTIC SURGEONS® How to Become an International Member: MOU Countries If you have been actively engaged in the practice of plastic or reconstructive surgery for at least three (3) years and reside and practice in a country other than the United States or Canada you may be eligible to become an International Member of the American Society of Plastic Surgeons® (ASPS®). The governing Boards of ASPS and your National Society have entered into a Memorandum of Understanding (MOU) between our organizations. The MOU provides for mutual recognition of standards, governance and ethics; and acknowledges the eligibility of all active/full members of each National Society to join ASPS as an International Candidate, Resident or Member. Because of the high standards of practice your National Society subscribes to, they are able to sponsor you for membership in the American Society of Plastic Surgeons if you are an active/full plastic surgeon member in good standing in your National Society. You do not need a letter of sponsorship from another ASPS Active, Life, or International Member. ASPS and your National Society have entered into this agreement with a spirit of mutual cooperation and sharing of information. You are required to maintain your membership in your National Society in order to maintain your membership in ASPS. You must also subscribe to the ASPS Code of Ethics. STEP 2: Once you have submitted all the requested materials, your application will be reviewed by the Membership Committee. 1. If you have been in practice less than three years, you will become an International Candidate Member of ASPS following review of your application by the Membership Committee. 2. If you have been in active practice three years or more, you will be placed in the International Member category. The Membership Committee will recommend approval or disapproval to the Board of Directors. Election to International Membership shall be by a majority vote of the Board at a meeting at which a quorum is present. 3. All fees, dues or assessments must be paid before being elevated to International Candidate or International Member category. 5496 STEP 1: 1. Complete the enclosed Application for International Membership. 2. Obtain a letter from the president, secretary or other authorized officer of the national plastic surgery society in the country where you are practicing which attests to your membership in good standing. The letter must include the date you became a member of your National Society. 3. Submit the completed membership application, letter confirming your nation’s plastic surgery society membership, a recent portrait-photograph, and the $125 application fee (U.S. Dollars) to the ASPS Executive Office: Membership Services American Society of Plastic Surgeons 444 East Algonquin Road | Arlington Heights, IL 60005-4664 **All information must be submitted in English. AMERICAN SOCIETY OF PLASTIC SURGEONS® International Membership Benefits International Members receive the following benefits: UÊiVÌÀVÊÃÕLÃVÀ«ÌÊÌÊ*>ÃÌVÊ>`Ê,iVÃÌÀÕVÌÛiÊ-ÕÀ}iÀÞ® Scientific Journal* UÊiVÌÀVÊÃÕLÃVÀ«ÌÊÌÊ*>ÃÌVÊ-ÕÀ}iÀÞÊ iÜî UÊiLiÀÊ«ÀViÃÊÊ-*-Ê«À}À>Ã]Ê«À`ÕVÌÃÊ>`ÊÃiÀÛVià UÊiLiÀÊ«ÀViÃÊÊ*>ÌiÌ`ÕV>ÌÊ>ÌiÀ>à UÊÃÌ}ÊÊÌ iÊiÊ-*-ÊiLiÀÊ,ÃÌiÀ UÊ >iÊ>`Ê>``ÀiÃÃÊÃÌ}ÊÊÌ iÊ-*-ÊÜiLÃÌi\ÊÜÜÜ°«>ÃÌVÃÕÀ}iÀÞ°À} UÊVViÃÃÊÌÊÌ iÊiLiÀÃÊ"ÞÊÃiVÌÊvÊÌ iÊ-*-Ê7iLÃÌi International Candidates receive the following benefits: UÊiVÌÀVÊÛiÀÃÊvÊ*>ÃÌVÊ-ÕÀ}iÀÞÊ iÜî UÊiLiÀÊÀ>ÌiÃÊ>ÌÊÃÞ«Ã>Ê>`Ê>Õ>ÊiiÌ} UÊÃVÕÌi`ÊiiVÌÀVÊÃÕLÃVÀ«ÌÊÌÊ*>ÃÌVÊ>`Ê,iVÃÌÀÕVÌÛiÊ-ÕÀ}iÀÞ® Scientific Journal *Print subscription available at an additional cost of $225 annually. 5496 If you have any questions about International Membership benefits or the membership process please contact: ASPS Member Services Center 847-228-9900, ext. 471 [email protected] Membership Advantage AMERICAN SOCIETY OF PLASTIC SURGEONS® Application for International Membership International Membership is open to qualified plastic surgeons who reside and practice in a country other than the United States or Canada. International Membership is an honor and is granted only to those plastic surgeons who have achieved professional distinction in their home country. Attached 2” x 2” Photograph *The following information must be submitted in English. Date: ________________________________ Name: __________________________________________________ (Please Type or Print) Spouse First Name: ___________________ Office Address: _________________________________________________________ Tel No.: _____________________________ _________________________________________________________ Fax No.: _____________________________ _________________________________________________________ Public Email: _________________________ _________________________________________________________ Private Email: ________________________ __________________________________Postal Code: ____________ Home Address: _________________________________________________________ Tel No.: _____________________________ _________________________________________________________ Fax No.: _____________________________ __________________________________Postal Code: ____________ Age: __________ Date of Birth: ________________________ Place of Birth: _________________________________________________________________________________________ Citizen of: _____________________________________________________________ Years in Practice: _______________ Sponsor: ______________________________________________________________________________________________ 5496 ______________________________________________________________________________________________________ Pre-Medical Education: __________________________________ Degree:_____________________ Date: ___________ ____________________________________________________________________________________________________ Medical School: ________________________________________ Degree:_____________________ Date: ___________ ____________________________________________________________________________________________________ Other: ________________________________________________ Degree:_____________________ Date: ___________ ____________________________________________________________________________________________________ Internship: _____________________________________________ Date: _______________________________________ ____________________________________________________________________________________________________ Residencies: General Surgery: _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ Plastic Surgery: _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ Other: _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ Board Certification: Plastic Surgery: _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ _______________________________________________ Dates: _______________________________ 5496 Other: Military Experience: ____________________________________________ Begin Dates: __________________________ ________________________________________________________________ End Dates: __________________________ Teaching Appointments (present): ______________________________________________________________________ ____________________________________________________________________________________________________ Hospital Appointments (present): ______________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Medical Society Membership (present): _________________________________________________________________ ____________________________________________________________________________________________________ Other: _____________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Other Training, Research, Teaching, etc.: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Special Awards or Recognition (any field): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 7 iÊ>Ê««V>ÌÊvÀÊÌiÀ>Ì>ÊiLiÀà «Ê>`ÊvÊiiVÌi`ÊÌÊiLiÀà «ÊÊÌ iÊiÀV>Ê-ViÌÞ of Plastic Surgeons®, I agree to abide by the Society’s Bylaws and Codes of Ethics, I understand and agree that membership in the American Society of Plastic Surgeons® is a privilege and not a right, and that as an applicant for membership, I have the responsibility for supplying to the American Society of Plastic Surgeons information adequate for a proper evaluation by the Society of my fitness for membership. I therefore submit to the Society this application and the Authorization to Release Information. Please return with $125 (U.S. Dollars) application fee to: Membership Services American Society of Plastic Surgeons 444 East Algonquin Road Arlington Heights, IL 60005-4664 5496 __________________________________ Signature AMERICAN SOCIETY OF PLASTIC SURGEONS® Authorization to Release Information In furtherance of my application for membership in the American Society of Plastic Surgeons (the “Society”), I hereby request and authorize any hospital, any medical staff, any medical organization, and any person who may have information (including medical records, patient records and reports of committees) that they deem relevant to my fitness for membership to provide such information to the Society. I further authorize the Society to provide any information it receives in connection with my application for membership in the Society to a state or county licensing authority, a state or county medical association, or an accrediting body provided I have authorized the licensing authority, medical association, or accrediting body to obtain such information. The Society shall not be liable for acts performed in connection with the collection, evaluation, or dissemination of information or opinions, whether or not requested or solicited, in connection with my application for membership in the Society. I shall not demand, through any judicial process, access to any information accumulated or prepared by the Society in considering my application for membership. ______________________________________________________ Signature ______________________________________________________ Name 5496 ______________________________________________________ Date
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