Active Membership Application

MEMBERSHIP APPLICATION FORM

Please refer to our the GTSC Membership Benefits page to confirm your eligibility prior to completing the Membership Application Form. Applicants who do not meet the requirements of membership will be denied and payment refunded.

Privacy Policy: All information collected here is for GTSC use. GTSC will not give out any personal data on this site without your express permission.

Security Policy: We will protect personal information by reasonable security safeguards against loss or theft, as well as unauthorized access, disclosure, copying, use or modification.

Cancellation Policy: Cancellations will not be provided for membership of the General Thoracic Surgical Club unless rejected. Please contact info@gtsc.org regarding questions, or concerns.

Refund Policy: GTSC membership refunds will not be provided unless application is rejected.

Membership Dues

Your Dues Rate Type is: Active Member

Contact Information

Email *

Re-enter your email *

First Name *

Middle

Last Name *

Credential(s) *

Title

Informal Name

Company *

Address 1 *

Address 2

Address 3

City *

State

Zip Code *

Country *

Website

Personal LinkedIn URL

Personal Twitter URL

Personal Facebook URL

Company LinkedIn URL

Company Twitter URL

Company Facebook URL

Profile Photo

Phone Number *

Fax Number

CC Email

Include me in Membership Directories *
Yes No

Include me in GTSC email communications *
Yes No

Member Login/Password

Please enter the Member Login/Password you would like to use to login to this website.

Your Member Login must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Member Login *

Password *

Confirm Password *

Additional Information

Birth Year (XXXX) *

Month & Year Certified in Thoracic Surgery: (month/year) *

GTSC requires that applicants devote at least 50% of their practice to general thoracic surgery in order to qualify for membership. My percentage of practice devoted to General Thoracic Surgery is: *
Less than 50%
Greater than 50%

NameCoach.com
In an effort to promote diversity, inclusion and belonging, GTSC kindly requests that all members to utilize the free website NameCoach.com to create a recording of their name. NameCoach aims to solve the common problem of name mispronunciation and gender pronoun communication in as many critical settings as possible.

Once you have created a website link of your recorded name, please paste the web link in the box below. This process should take less than 10 minutes of your time.

Please click here for step-by-step instructions.

Example Recording: https://www.name-coach.com/sidhu-gangadharan

Please paste the link to your NameCoach here *

Phonetic Spelling of Your Name *

ATTENTION: The applicant must send the below link to TWO Active or Senior members of the Club (or two individuals familiar with your practice if you do not know an Active or Senior member) and ask that they complete/remit. This brief form replaces the need for a letter of recommendation. Without two completed forms, GTSC cannot accept the application.

Member Sponsor Form Link: www.gtsc.org/MemberSponsorForm

Please state the names of the sponsors you will be sending the form to

Sponsor 1 Name: *

Sponsor 2 Name: *

GTSC may request a complete list of all operations performed in the year, which would need to be certified by the chief(s) of surgery at your institution(s).

Payment Details

Comments

Amount to Charge :

Payment Method:

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Bank Name:
Bank Account Holder Name:
Routing Number:
Account Number:
Account Type:

Name on Card:

Card #:

Expires:

CSC (What's this?):

Billing Street:

Billing Zip Code:

Enable Automatic Renewals?

Select "Yes" in order to be enrolled in automatic membership renewal. The above payment method will become your saved payment method, overwriting anything that may have been previously saved and will be used for future renewals. You can change the automatic renewal setting or saved payment method at any time in either the "Payment Method" or "Membership Auto-Renewal" tabs where you edit your profile.

No Yes

Active Membership Application

MEMBERSHIP APPLICATION FORM

Please refer to our the GTSC Membership Benefits page to confirm your eligibility prior to completing the Membership Application Form. Applicants who do not meet the requirements of membership will be denied and payment refunded.

Membership Dues

Contact Information Contact Information

Member Login/Password Member Login/Password

Additional Information Additional Information

Payment Details Payment Details

Contact Information

Member Login/Password

Additional Information

Payment Details