Louisiana YFA Committee
About You
Full Name
*
First Name
Middle Name
Last Name
Suffix
Designation
*
MD
DO
MD, FACS
DO, FACS
Other
Academic Program/Practice Name
*
Email
*
example@example.com
Cell Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Membership Type
*
Please Select
Active
Associate
Your Discipline
*
General Surgery
Trauma/Critical Care
Breast Surgery
Vascular Surgery
Transplant Surgery
Thoracic Surgery
Cardiac Surgery
Otorhinolaryngology
Orthopedic Surgery
Urology
Pediatric Surgery
Colorectal Surgery
Surgical Oncology
Plastic Surgery
Minimally Invasive/Bariatric
Social Media
Social Media Platforms
*
Twitter
Facebook
Instagram
TikTok
Not on social media
Your Interest
Your interest (check all that apply)
*
Advocacy
Mock Orals
Chair a Committee
Serve on the Program Committee
Serve as a Chapter Liaison
Social Media Takeover
Share an event or idea for the chapter.
Submit
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