Fellow Membership Application

Becoming a Fellow of the Florida Society of Dermatologic Surgeons (FSDS) is your chance to step into leadership, expand your voice in the Society, and be recognized for your commitment to excellence in dermatologic surgery.

Why Apply?
As an FSDS Fellow, you enjoy all the rights of General Membership plus:
- Eligibility to run for elective office.
- Opportunity to chair or serve on committees and councils.
- Recognition as a leader within the Florida dermatologic surgery community.
Applicant Information
Name

First NameLast Name
Credentials
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Requirements for Application
Simple Requirements
- Be a General Member in good standing for at least 2 years
  (Members may be fast tracked to Fellow status per recommendation of a current Board Member)
- Hold a current medical license
- Complete this application and select ONE of the following to provide:
Select ONE of the following, send via email to fsds@fsds.org upon submitting your application.
Date

MonthDayYear
Date
Signature
Should be Empty:

Applicant Information