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Campagna di associazione SICPRE/ASPS

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!!!SOCIETA’ ITALIANA CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA!
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!!!!!!!!!!!!!!!!!!!!!!!!!! Campagna di associazione SICPRE/ASPS
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!( Codice della Campagna: N° 279 )
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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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.
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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:
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International Candidates receive the following benefits:
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*Print subscription available at an additional cost of $225 annually.
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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: ______________________________________________________________________________________________
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______________________________________________________________________________________________________
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: _______________________________
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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…ˆiÊ>˜Ê««ˆV>˜ÌÊvœÀʘÌiÀ˜>̈œ˜>Êi“LiÀň«Ê>˜`ʈvÊiiVÌi`Ê̜ʓi“LiÀň«Êˆ˜Ê̅iʓiÀˆV>˜Ê-œVˆiÌÞ
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
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