Membership Application | Musculoskeletal Infection Society

Thank you for your interest in applying for membership in MSIS. Membership is open to any healthcare professional with a demonstrated interest in advancing the knowledge and care of musculoskeletal infections. To apply, please do the following:

Fill out the form on this page
Obtain one letter of support from a current member of MSIS. Have the letter of support emailed directly to MSIS (email letters to msis.marcy@gmail.com) by the person submitting it. If you do not know any current MSIS members, choose an accomplished healthcare professional who is acceptable to the MSIS Membership Committee, who is able to speak to your interest, participation and commitment to the care of patients with musculoskeletal infection.
Upload a current curriculum vitae that includes the content listed below. Your work in musculoskeletal infection should be evident on your CV.
Please note that maintaining membership requires that you attend the MSIS annual meeting at least once every four years.

Title:*
First Name:*
Middle Initial:
Last Name:*

Email address:*
Date of Birth:*

Password:*
Re enter Password:*

Specialty:*
Would you like to show your profile on Find a physician map?

Other Specialization:*

Profile Photo:
(Please upload only jpg, jpeg, png image. Maximum Size: 2MB)
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Work Information (Public):

(Following your approval, work information will be displayed on the Find-a-Physician page.)

- Practice Name: *
- Phone Number
- Work address Line 1 *
- Work address Line 2 *
- Country: *
- State *
- City *
- Zip Code *

Home Information (Private):

- Private Phone Number
- Home address Line 1 *
- Home address Line 2 *
- Country: *
- State *
- City *
- Zip Code *

What percent of your practice is dedicated to care of Musculoskeletal Infection? *

Percent Musculoskeletal Infection:*

Letter of Support:

(Name and email address of the person who will write your Letter of Support.)

- Name:*
- Email:*

Curriculum vitae:*

You must upload a CURRENT CV that includes the following information.

1. Education: including degrees achieved,
2. Employment including title and Academic Appointments (including Rank) with Continuous timeline from high school to present
3. Medical Licenses and Board Certifications, including issue date and expiration
4. Medical and Professional Society participation, including Dates, Status Committee participation and leadership
5. Medical Practice, including areas of clinical interest
6. Academic activities, NUMERICALLY listed
1. (i) Peer Review Publications
2. (ii) Peer Review Presentations at International, National, State and regional meetings
3. (iii) Invited lectures and Key note addresses at International, National, State and regional meetings
4. (iv) Visiting Professorships
5. (v) Text Books
6. (vi) Book Chapters
7. (vii) Media/Video/Webinar
8. (viii) research areas of activity
9. (ix) research funding

(N.B: Please upload only PDF. Maximum Size: 5MB)

Agreement:

The undersigned specifically authorizes MSIS to make whatever inquiries and investigation it deems necessary to verify the credentials, professional standing and moral and ethical character of the undersigned. MSIS will consider the contents of this application not marked as public, as well as information gathered from all inquiries or investigations made pursuant thereto as privileged and confidential material and will not publish or publicly disseminate that information unless required by law. The undersigned agrees that if accepted as a member, he/she will not cause or attempt to cause any public disclosure of private MSIS information including any application for Membership in the MSIS, any proceedings of any MSIS Committee, and any proceedings of the Board of Directors, unless required by law. Participation in one Annual Meeting of the MSIS every four years is required for maintenance of Membership.

By typing your name on the Signature line you are making your commitment equal to writing your signature by hand. Your typed signature must match your entered name exactly.

Signature of Applicant:*
Date :*

Do you authorize MSIS to make your profile appear on the website?*
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