Register

Personal details

First name: « Required
Last name: « Required
Email: « Required
Phone (Work): « Required
Phone (Home):
Mobile:
P/A Email:
 

Membership type

Membership type: « Required
Which membership type is right for me?

Address

Country: « Required
Street: « Required
Suburb: « Required
State/Province: « Required
Postcode: « Required

Practice Address

Practice name: « Required
Country: « Required
Street: « Required
Suburb: « Required
State/Province: « Required
Postcode: « Required

Password

Please choose a password for your account. You need to enter it twice to make sure you got it correct.

Password: « Required
Repeat password: « Required

Additional Information

Date of Birth: / / Select
Place of Birth:
Spouse's name:

Proposer and Seconder

Please let us know who is proposing you join the society and who is seconding the motion.

Proposer name: « Required
Seconder name: « Required

Documentation

Please select a copy of your most recent C.V.

C.V. File: « Required

Include a recent photograph of yourself.

Photograph: « Required

Include a letter from your proposer.

Letter: « Required

Include a letter from your seconder.

Letter: « Required

Supporting Information

Please tell us about your qualifications, appointments and publications

Degrees and Diplomas (with dates and locations): « Required
Present Surgical Appointments: « Required
Publications Relevant to Hand Surgery: « Required

Logbook / Work History

A logbook is required for your membership type, how would you like to submit this?

Logbook submission type: « Required

Please tell us the number of times you have undertaken the following procedures:


A) Trauma

1. Fracture fixation:
Phalangeal and metacarpal:
Scaphoid:
Other carpal:
Distal radius:
2. Dislocations / instabilities:
Surgical reconstruction:
Carpal:
Carpometacarpal:
Metacarpophalangeal:
Interphalangeal:
3. Flexor tendon:
Actute repair:
Reconstruction:
4. Extensor tendon:
Actute repair:
Reconstruction:
5. Skin:
Skin graft:
Local flaps:
Regional flaps:
Distant flaps:
Free tissue transfer:
Nail bed injuries:
6. Nerve:
Primary repair - digital:
Secondary reconstruction:
7. Brachial plexus surgery - trunk:
8. Vessel repair or reconstruction:
9. Replantation:
10. Multiple Injuries*:

* Multiple injuries include any 3 of bone, tendon, nerve, vessel, skin reconstruction
If 2 structures are repaired, document twice under appropriate heading.
If 3 structures are repaired, document under "multiple injuries".

B) Elective

1. Rheumatoid procedures:
2. Degenerative OA:
Inf RUJ:
Wrist and carpus:
Fingers & thumb:
3. Arthroscopic procedures:
Wrist, Inf RUJ, carpometacarpal:
4. Carpal instabilities:
Surgical reconstruction:
5. Tumors:
6. CTS:
7. Cubital tunnel syndrome:
8. Other nerve compression:
9. Tendon transfers:
10. Congenital:
11. Tetraplagia:
12. Spastic deformity:

Please select an up to date version of your logbook

Logbook File: « Required

Terms and conditions

« Required