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Graduate Training / Residency:

(Attach letter from Chairman of program verifying completion of training if not yet certified)

Recommended for membership by:

Please note: In making application for membership to the Northwest Society of Plastic Surgeons, you agree to abide by the Constitution and By-Laws of the Society and by such rules and regulations which may be from time to time enacted. Moreover, you hereby declare that you are a plastic surgeon in compliance with the Ethics rules of the American Society of Plastic Surgery (ASPS).

I accept the terms and conditions above.


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