The South African Knee Society.

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Application for Membership

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Personal Information

Surname

First Name

Title

Prof Dr Mr Mrs Miss Other
Degree:

Mailing Address:

Code

Telephone Number:

Fax:

Cell Phone:

Email:

Date of Birth:

Sex:

Male Female

State your membership of other local and international societies.
SAOA Active Assoc. Subspeciality ISAKOS
Other:

Which SA Knee Society meetings have you attended?

Academic Information

University

Degree

Undergraduate

Year

Postgraduate

Fellowships

Publications/Presentations: Please attach a list to this application

Standard Practice Information

Academic Affiliation

Hospital Affiliation

Practice Setting:

University | Private | Both

No. of Cases /year:

Arthroscopy
Knee Surgery
Arthroplasty

Sponsor Form B

Sponsor’s Name:

All applicants who are applying for Membership must supply at least one sponsor form, which must be completed by an Active Member of The SA Knee Society. The sponsor should be an orthopaedic surgeon in your area.

The information you provide will only be reviewed by the Executive Committee. All answers and additional comments are confidential.

1. Are you an Active Member of The SA Knee Society?	Yes No
2. How long have you known the applicant?	0 - 5 years 5 - 10 years 10 or more years
3. In what capacity have you worked with the applicant?	Partner/Associate Fellowship Registrar Other
4. Describe your current professional affiliation with the applicant:: 9. Do you recommend the applicant for Active Membership in ISAKOS? Yes No Comments:

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