Application for Membership – Active/Associate

Date of Application*

Highlight or underline your requested Membership Type*
Active Surgery MemberAssociate Surgery MemberActive Craniofacial Orthodontia MemberActive Research MemberCorresponding Member
Residents/Registrar/Fellows please use the other Application Form!
First Name*

Middle Initial

Last Name*

Degree (MD, DDS etc)*

Email*

Office Phone*

Mobile Phone*

Mailing Address*

Address 2

City*

State/Province/Region

ZIP/Postal Code*

Country*

Practice Information

Practice Name/Hospital Affiliation*

Practice Address*

Practice Address 2

Practice City/State*

Practice Country*

Practice Email*

Practice Phone*

Practice Fax

Practice Website*

Professional Qualifications

List of Craniofacial Operations*
Click here to download the list of relevant cases. Fill in with the number of procedures performed in the last two years, and upload here.

Clinical Team Members*
Attach a list of your clinical team members stating their names and specialty.

Resume/Curriculum Vitae*
Include a list of publications and scientific contributions.

Attach Letters of Sponsorship*
Letters of sponsorship from two presently active members of this Society.

Attach a Letter of Recommendation from the head of the program where you trained in craniofacial surgery for at least six months (if surgery is your specialty).

Application Fee* – 75.00 USD

The application fee can be paid by secure credit card link: CLICK HERE
The application fee will serve as your first-year membership fee. Annual membership in this category after that is currently 150 USD If you prefer to mail a check, it should be made payable to: ISCFS
and mailed to:
ISCFS Administration | 38 Rayton Road | Hanover, NH 03755 USA

Certifications

I certify that I am a legally qualified practicing surgeon, active in craniofacial surgery. I have been in active practice of craniofacial surgery for at least five years.
I certify that I am an active member of a major medical specialty society and practice this specialty in my country.
If non-surgeon specialist: I am actively engaged in a craniofacial team.
I hereby certify that all information submitted in this application is accurate and complete.*