RJOS Membership Application

RJOS Membership Application
Instructions
Choose the appropriate Membership Category from the descriptions below

All applications must upload a CV (PDF version only)

All Resident and Fellow applicants must upload a letter from your Residency or Fellowship Program verifying your status of training (PDF version only)

All Student applicants must upload a letter from your Registrar or Dean of Students certifying your registration in medical school (PDF version only)

Submit the completed application, with all required uploaded documentation
Membership Category Descriptions
Active - Orthopaedic surgeon, ABOS, or FRCS(C) certified in the United States or Canada

Candidate - Orthopaedic surgeon not yet ABOS or FRCS(C) certified

Affiliate - PhD, research scientist or other non-MD applicant with strong interest(s) in orthopaedics

Corresponding - Orthopaedic surgeons practicing outside of the United States or Canada

Fellow - Physician in an orthopaedic surgery fellowship program

Resident - Physician in an orthopaedic surgery residency training program

Student - Student interested in pursuing a career in orthopaedic surgery
Select One Membership Category *

Active - Annual Dues $260.00 Candidate - Annual Dues $260.00 Candidate (First 3 years of practice only) - Annual Dues $160.00 - See required question below. Affiliate - Annual Dues $110.00 Corresponding - Annual Dues $60.00 Fellow - Annual Dues $55.00 Resident -Annual Dues $55.00 Student - Annual Dues $40.00
To qualify for discounted Candidate rate for first 3 years of practice only, please enter the date your practice began here.
Name *

First Name Middle Name Last Name Credential
NPI Number
Gender *

Male Female
Birth Date *

Month Day Year
What is your Ethnicity?

African American Asian American Caucasian Hispanic/Latino Multi-Racial Native American Native Hawaiian Other I do not wish to disclose
Primary Address *

Office Address Home Address
Practice or Institution Name

Street Address Line 2

City State / Province

Postal / Zip Code
Office Email
example@example.com
Office Phone Number

Area Code Phone Number
Name of Alternate Contact in your office (Admin or Office Manager)
Email of your Alternate Contact (Admin or Office Manager)
Home Address

Street Address

City State / Province

Postal / Zip Code
Home Phone Number

Area Code Phone Number
Personal Email
example@example.com
What is your Specialty?

General Arthroplasty Foot & Ankle Hand Oncology Pediatrics Shoulder & Elbow Spine Sports Trauma
Year of Board Certification
Certified By

ABOS FRCS
Licensed to practice medicine in (state/country)
Type of practice setting (University, Private Practice, etc.)
Hospital or University Affiliations
How did you hear about RJOS?

Recommendation from friend or colleague From RJOS website Grant or scholarship opportunities Attended past RJOS meeting or event
How can RJOS help you in your career?

Professional Development opportunities Grant or scholarship opportunities From RJOS website Opportunity to be matched with an RJOS Mentor
Upload Required Documentation

Upload in PDF only
All Applicants Must Upload a CV *

Browse Files
PDF Only Cancel of
All Resident and Fellow Applicants must upload a letter from your Residency or Fellowship Program verifying your status of training

Browse Files
PDF Only Cancel of
All Student applicants must upload a letter from your Registrar or Dean of Students certifying your registration in medical school

Browse Files

Cancel of
Payment
Upon approval of your application for membership in the Ruth Jackson Orthopaedic Society, an invoice will be emailed to you. Payment must be received within 30 days from the date of the invoice to activate your membership.
Confirmation

Completion of this application serves as your authorization allowing the Society to investigate your credentials, including but not limited to, contacting any medical society, state licensing board or the hospital at which you have privileges.
By checking this box, I hereby agree to adhere to the Bylaws and pertinent policies and procedures of the Ruth Jackson Orthopaedic Society. *

Agree
Date of Application *

Month Day Year
Date
Should be Empty:

RJOS Membership Application

Instructions

Membership Category Descriptions

Upload Required Documentation

Payment

Confirmation