Profile Information

Honorific
== select == Mr. Ms. Miss Mrs. M. Mme. Dr. Hon.

First Name

Middle Name/Initial

Last Name

Title/Position

E-mail

Birth Date
(month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec , 

Language
 English    French

Education/Certification Information

Hospital/Clinic

Junior

Please indicate what Resident or Fellowship year you are in:

Last year of Residency

Fellow Associates, please specify year:
Year 1:
Year 2:
Other:

Program Director

Sponsor 1

Sponsor 2

University Affiliation

I am certified by:

 FRCSC (Fellow of the Royal College of Surgeons Canada)  
Year:

 CCMQ (Certifié(e) par Collège des médecins du Québec)  
Year:

 ABPS (American Board of Plastic Surgery)  
Year:

Other:
Year:

I am interested in volunteering for the CSPS as: (check as many as apply)
 Board Member  
 Membership Committee  
 Social Media and Website Committee  
 Public Relations Committee  
 Young Plastic Surgeons Committee  
 Workforce Committee  
 Sustainable Action Committee  
 Program Committee  
 Ethics Committee  
 Judicial Committee  
 Nominating Committee  
 Plastic Surgery Journal Committee  
 International Observership Committee  
 Gender Affirming Surgery Taskforce  
 Educational Foundation  

I would be interested in helping out with the Annual Scientific Meeting as: (check as many as apply)
 Speaker/Panelist  
 Panel Moderator  
 Local Host  
 Scientific Session Moderator  
 Scientific Session/Poster Session Judge  
 Abstract Reviewer  
 Abstract Review Committee  

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