Follow the steps to complete your application successfully.

1. Use the 'Get Form' button to access the application form and open it in your preferred online editor.
2. Begin filling out the form by entering your personal information, including your name, spouse's first name (if applicable), and contact details such as your office and home phone numbers, cell number, fax number, and email addresses.
3. Next, provide your date of birth and pre-medical education details, including degrees obtained, the medical school attended, and any additional degrees.
4. Document your internship and residency details, specifying dates for general surgery and plastic surgery training.
5. If applicable, include information on any fellowships completed, along with the respective dates.
6. Indicate your board certification status in plastic surgery and any other certifications, including relevant dates.
7. Describe any military experience, including active and reserve service, as well as teaching appointments and hospital appointments.
8. List your current medical society memberships, such as membership in the American Medical Association (AMA) or the American College of Surgeons (ACS), along with any other affiliations.
9. Provide information about additional training, research, teaching experiences, or any special awards or recognitions received.
10. Review the agreement statement regarding the understanding of membership privilege and ethical obligations, then sign and date the application.
11. Complete the payment section, selecting your method of payment, and include the necessary cardholder information if using a credit card.
12. Once all sections are filled out, ensure all information is correct before saving changes, downloading, or printing the application for submission.

Submit your application now to take the next step in your professional journey!