Membership Application

ISS Application For Membership

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  • APPLICATION INSTRUCTIONS:

    1. THE CANDIDATE SHALL COMPLETE ALL PORTIONS OF THE APPLICATION FORM. NOTE: NO PAGES ARE TO BE ATTACHED TO THE APPLICATION –ALL REQUIRED INFORMATION IS TO BE INCLUDED ON APPLICATION.
    2. THE APPLICANT MUST HAVE ONE SPONSOR WHO IS AN ACTIVE MEMBER IN THE SOCIETY.
    3. THE APPLICANT SHOULD RETURN TO DR KONSTANTIN UMANSKIY, SECRETARY AND TREASURER OR THE ILLINOIS SURIGICAL SOCIETY, FOR REVIEW BY THE BOARD OF GOVERNORS.
    4. THE SPONSOR AND THE TWO ENDORSERS SHOULD EACH SEND A LETTER OF RECOMMENDATION FOR THE CANDIDATE DIRECTLY TO THE SECRETARY OF THE SOCIETY.

    SEND COMPLETED APPLICATION TO:
    Konstanin Umanskiy, MD
    IllinoisSurigicalsociety@gmail.com
    OR via post to:
    5841 S Maryland Ave. MC5095
    Chicago, IL 60637