WESTERN VASCULAR SOCIETY APPLICATION FOR CANDIDATE MEMBERSHIP

Eligibility:

Candidate membership may be conferred upon vascular surgery residents and fellows in accredited vascular surgery training programs in the Western Vascular Society region, and vascular surgery physicians graduated from accredited vascular surgery programs who do not meet qualifications for active membership.

Benefits of Candidate Membership:
Candidate members may present papers at the annual meeting if sponsored by an active member.
Candidate members shall not be bound by the requirements for payment of dues and attendance at meetings.

Candidate members may not hold office but may serve on committees.

Exceptions:

Candidate members who move out of the region of the Society shall cease to be candidate members.
Candidate members shall have a maximum term of three consecutive years following completion of training.

First Name *

Last Name *

Designation (MD, DO, MSc etc.):

Institution *

Education Status (ex: MS3, PGY-2) *

Anticipated date of Vascular Surgery Certification (mm/yyyy): *

Mailing Address (for certificate) *

Address Line 2

City *

State/Province: *

Zip/Postal Code: *

Country

Phone Number *

Personal Email Address *

Date of Birth (mm/dd/yyyy) *

Social Media Tags (Instagram, X, Twitter etc.):

CV/Resume *

Headshot/Profile Photo

Vascular Program Director Full Name: *

Vascular Program Director Email: *

Letter of Recommendation from Vascular Program Director

PROGRAM DIRECTORS MAY ALSO SEND COMPLETED LETTERS OF RECOMMENDATION TO:

Dr. Christian Ochoa
Membership Committee Chair
Western Vascular Society
Email: admin@surgicalcs.com

I CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE *

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