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Personal details

First name:

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Last name:

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Email:

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Phone (Work):

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Phone (Home):

Mobile:

P/A Email:

	Allow my P/A to receive emails
	Share my contact details on the public register

Membership type

Membership type:		Required

Which membership type is right for me?

Address

Country:		Required
Street:
Suburb:
State/Province:
Postcode:

Practice Address

Practice name:		Required
Country:		Required
Street:
Suburb:
State/Province:
Postcode:

Password

Please choose a password for your account. You need to enter it twice to make sure you got it correct.

Password:		Required
Repeat password:		Required

Additional Information

Date of Birth:	Date of BirthDay: / Month: / Year:Select
Place of Birth:
Spouse's name:

Proposer and Seconder

Please let us know who is proposing you join the society and who is seconding the motion.

Proposer name:		Required
Seconder name:		Required

Documentation

Please select a copy of your most recent C.V.

C.V. File:		Required

Include a recent photograph of yourself.

Photograph:		Required

Include a letter from your proposer.

Letter:		Required

Include a letter from your seconder.

Letter:		Required

Supporting Information

Please tell us about your qualifications, appointments and publications

Degrees and Diplomas (with dates and locations):		Required
Present Surgical Appointments:		Required
Publications Relevant to Hand Surgery:		Required
Areas of interest:

Logbook / Work History

A logbook is required for your membership type, how would you like to submit this?

Logbook submission type:		Required

Please tell us the number of times you have undertaken the following procedures:

A) Trauma

1. Fracture fixation:
Phalangeal and metacarpal:
Scaphoid:
Other carpal:
Distal radius:

2. Dislocations / instabilities:
Surgical reconstruction:
Carpal:
Carpometacarpal:
Metacarpophalangeal:
Interphalangeal:

3. Flexor tendon:
Actute repair:
Reconstruction:

4. Extensor tendon:
Actute repair:
Reconstruction:

5. Skin:
Skin graft:
Local flaps:
Regional flaps:
Distant flaps:
Free tissue transfer:
Nail bed injuries:

6. Nerve:
Primary repair - digital:
Secondary reconstruction:

7. Brachial plexus surgery - trunk:

8. Vessel repair or reconstruction:

9. Replantation:

10. Multiple Injuries*:

* Multiple injuries include any 3 of bone, tendon, nerve, vessel, skin reconstruction
If 2 structures are repaired, document twice under appropriate heading.
If 3 structures are repaired, document under "multiple injuries".

B) Elective

1. Rheumatoid procedures:

2. Degenerative OA:
Inf RUJ:
Wrist and carpus:
Fingers & thumb:

3. Arthroscopic procedures:
Wrist, Inf RUJ, carpometacarpal:

4. Carpal instabilities:
Surgical reconstruction:

5. Tumors:

6. CTS:

7. Cubital tunnel syndrome:

8. Other nerve compression:

9. Tendon transfers:

10. Congenital:

11. Tetraplagia:

12. Spastic deformity:

Please select an up to date version of your logbook

Logbook File:		Required

Terms and conditions

I have read and understand the terms and conditions of registration.

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Personal details

Membership type

Address

Practice Address

Password

Additional Information

Proposer and Seconder

Documentation

Supporting Information

Logbook / Work History

A) Trauma

B) Elective

Terms and conditions

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