Florida Hip Preservation Society Membership Aplication InstagramThis field is for validation purposes and should be left unchanged.Applicant informationFull NameCredentialsPrimary Practice or InstitutionProfessional Title / RoleWork AddressCityEstateZip codeEmail(Required) PhoneMembership Category Select one primary category and applicable sub-categories. Physician MemberMake a SelectionOrthopaedic SurgeonFor Orthopaedic Surgeons OnlyNon-surgical Physician (Sports Medicine, PM&R, etc.)Hip arthroscopy proceduresPeriacetabular Osteotomy (PAO)Femoral OsteotomyAnnual Dues: 300 USDFellow MemberMake a SelectionOrthopaedic SurgeonFor Orthopaedic Surgeons OnlyNon-surgical Physician (Sports Medicine, PM&R, etc.)Hip arthroscopy proceduresPeriacetabular Osteotomy (PAO)Femoral OsteotomyAnnual Dues: 300 USDAffiliate / Non-Physician MemberMake a SelectionAdvanced Practice ProviderPhysician Assistant (PA)Nurse Practitioner (APRN/NP)Physical TherapistMusculoskeletal/hipPelvicAnnual Dues: 100 USDStudent / Non-Physician MemberMake a SelectionAdvanced Practice ProviderPhysician Assistant (PA)Nurse Practitioner (APRN/NP)Physical TherapistMusculoskeletal/hipPelvicAnnual Dues: 100 USDProfessional BackgroundPrimary clinical focus related to hip preservationPercentage of clinical practice dedicated to hip preservationBriefly describe your experience or interest in hip preservation (surgical or non-surgical)Licensure and CertificationState(s) of LicensureLicense Number(s)Board Certification(s) (if applicable)Link to your online profile/ websiteStatement of Professional ConductStatement of Professional Conduct(Required) "I affirm that I am in good professional standing and agree to uphold the mission, values, and ethical standards of the Florida Hip Preservation Society."Payment Only electronic payment is accepted. Checks and institutional payments are not accepted.Membership Dues300 USD (Physician)100 USD (Affiliate/Non-Physician)Only electronic payment is accepted. Checks and institutional payments are not accepted.Payment MethodCredit CardDebit CardOther approved online payment options (e.g., ACH, digital wallet)Optional: Committee or Engagement InterestsIndicate if you wish to participate in any society activities.EducationResearchAdvocacyAnnual Meeting PlanningMembership Outreach Δ
