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North Carolina Thoracic Society Membership Application

:

$50 Full Membership
Free > 65 yo or Trainee Fellow, Resident, Student

 

(*NC Thoracic Society members are not required to be a member of its parent organization - the American Thoracic Society. Elected Officers of the NC Thoracic Society must be members of the American Thoracic Society)

 

Section 1: Demographic Information

Last Name *
First Name *
Middle Name
Present Position
Address *
City *
State *
Zip Code *
Daytime Telephone *
Fax Number
EMail *
Education
MD   DO   RN   MN   RCP   PharmD   PhD  
If PhD, please specified your area of interest:
Primary Board Certification
Secondary Board Certification
Subspecialty Board

 

Section 2: General Information

Work Setting:
Institutional Practice
Private Practice
Basic Research - academic
Clinical Research – academic
Clinical Research – non-academic
Retired
Government
Public Health
Pharmaceutical Industry
Other

If Other:
As an NCTS member, would you like to be on a list which we share with the public requesting a membership listing? *
Yes   No  
As an NCTS member, please check any committees you would like to participate:
Advocacy
Research
Clinical Practice and Education
NCTS Meeting Program

 

Section 3A: Information

Please indicate any areas in which you have special interest or expertise. *
Allergy/Immunology
Adult Asthma
Chronic Obstructive Lung Disease
Critical Care Medicine
Cystic Fibrosis
Infectious Diseases
Interventional Pulmonary
Interstitial Lung Disease
Lung Cancer/Oncology
Environmental/Occupational Medicine
Palliative Care Medicine
Pathology
Pediatrics/Neonatology
Pulmonary Hypertension
Radiology
Reactive Airway Disease
Sleep Medicine
Tobacco
Transplant Medicine
Other

If Other:

 

Section 3B: Allied Health Professional Information

The criteria for membership are involvement in the provision of care, research, or advocacy related to lung health.
My expertise is in the following area(s):
Adult Critical Care
Pediatric Critical Care
Ambulatory clinic practice
Pharmaceutical industry
Clinical research
Pharmacy - community
Education
Pharmacy - institutional
Hospital
Public health
Management
Pulmonary rehabilitation
Non-clinic community practice
Pulmonary function testing
Other

If Other:

 

THE NORTH CAROLINA THORACIC SOCIETY

The North Carolina Thoracic Society (NCTS) is a non-profit professional and scientific society dedicated to lung health including pulmonary, critical care, sleep medicine, and public health. Our mission is to further medical education, scientific collaboration, and to promote advocacy for issues relating to lung health in the state of North Carolina. The Society is a state chapter of the American Thoracic Society and will work closely to support its parent organization. We represent academic and community physicians, trainees in pulmonary and critical programs, pulmonary allied health professionals, and other professionals involved in lung health.

 

Section 4: Application

I hereby apply for membership in the North Carolina Thoracic Society:
(Full Name Signature)
Please credit the NCTS member who urged you to join the Society:
Please indicate other professionals you would recommend for NCTS membership: