MEMBERSHIP

Offline Membership Form Option

Download the NSOCP Membership Application and fax to 520-545-1254 or mail completed form and payment to: National Society of Cosmetic Physicians 8040 S Kolb Rd Tucson, AZ 85706

MEMBERSHIP APPLICATION

Are you currently a practicing Physician performing liposuction and other cosmetics? Fill out the form below to become a member:

Membership application fee: $300.00
Resident application Fee: $150.00

Fields marked with * are required.

Name *

E-mail *

Address:

City

State

Zip:

Phone:

Fax:

Medical Specialty:

TITLE

OTHER TITLE

Business Address:

City:

State:

Zip:

Country:

Phone:

Fax:

Email:

Preferred Mail:

Preferred Phone:

Date of Birth:

Place of Birth:

Medical License #:

Medical License State / Country:

Date Obtained:

Is your license in effect and unrestricted:

Yes

Board certified:

Yes

Which board:

Date certified:

ABMS area(s) of surgical training:

Active membership in:

List accredited cosmetic workshop(s) and dates attended:

Cosmetic procedures currently performing:

How did you find out about us: *

Physician or Other Referral

E-mail a copy of this message to your own address.

MEMBER BENEFITS

A MUST FOR ANY PHYSICIAN WHO PERFORMS COSMETIC PROCEDURES!

Political strength among the practicing cosmetic physician
Often times, the most important information you can receive will come from colleagues within the field.

Certificate of Membership
Don't just say you're a member, show them you're a member

Certification of Completion on NSOCP workshops
Receive a certificate that shows you have completed CME accredited educational event on a particular subject

Updates regarding new monthly events
Receive emails and mailers on upcoming workshops and events so you can stay informed

CME credit on all NSOCP sponsored events
Every NSOCP event or sponsored event will be offered with CME's

Discount on all NSOCP sponsored education
Because continued education is important, stay informed for a discount on all workshop, symposiums and Annual Meeting

Use of the NSOCP logo
Members will receive free access to the use of the NSOCP logo

Social Network

Collaboration between members and the community through Facebook and LinkedIn

Access to our "Industry Sponsors"
Find companies who are innovating in your field.

By clicking the send button above, I agree that membership in the National Society of Cosmetic Physicians (NSOCP) is a privilege not a right. I recognize that the contents of this application will be seen by individuals working for NSOCP. I agree to surrender my membership and return my certificate if my license to practice medicine is revoked, suspended or limited beyond its present state, or if membership is revoked or terminated for such other cause as may be provided by the bylaws of the Society. Moreover, I acknowledge that membership in NSOCP does not qualify me as a certified physician to practice cosmetic procedures, and that membership alone in said Society is for educational purposes to advance knowledge and experience. Additionally, I agree to adhere to all rules regulations and policies as adopted by NSOCP. I furthermore understand that membership in NSOCP does not give me license to perform cosmetic procedures. Instead, it expresses my interest and participation in the studying of techniques. I hereby acknowledge and authorize use of the information I have provided for dissemination of information from or approved by NSOCP which it deems germane to my practice.

Offline Membership Form Option

MEMBER BENEFITS

Contact Info

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