MEMBERSHIP APPLICATION FORM
Applicant eligibility criteria
Physician Member :
Physician Membership is limited to doctors who have an M.D., M.B.B.S or equivalent medical degree and bearing current valid medical license in the area in which they practice.
I hereby apply for membership in the Asian Association of Hair Restoration Surgeons (AAHRS). (Hereafter referred to as AAHRS)
In consideration of AAHRS processing my application for membership, I hereby grant permission for the AAHRS to obtain information regarding hospital staff privileges and actions relating thereto, information from former medical Association affiliations, specialty organizations, medical schools and other organizations providing medical training including internship and residencies.
I further authorize disclosure of information generally considered to be reliable which has a bearing on my professional competence, character and ethical qualifications to all hospitals and medical licensing and discipline boards who request such information.
I hereby release and hold harmless from any liability or loss, the AAHRS, its officers, agents, employees and members for acts performed in good faith and without malice in connection with evaluating my application and my credentials and qualifications, and hereby release from an liability any and all individuals and organizations, who, in good faith and without malice, provide information to the AAHRS to its authorized representatives, concerning my professional competence, ethical conduct, character and other qualifications for membership.
I further release from liability the AAHRS, its officers, agents, employees and members for delivery of information to any third party as authorized herein provided such delivery occurs prior to the acknowledged receipt, in the office of the AAHRS, or a written notice of revocation of this release.
I have read and understand the Bylaws and Code of Ethics. I hereby agree to abide by the Bylaws and Code of Ethics of the AAHRS and agree upon acceptance. My membership in the AAHRS shall be conditional upon compliance of the aforementioned Bylaws and Code of Ethics.
I HEREBY AFFIRM AND REPRESENT THAT ALL STATEMENTS, ANSWERS AND INFORMATION CONTAINED IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Just insert your name in the signature)
Remarks: Please attach your most recent photo, copy of medical licensure, with the membership fee in USD.