Chapter Membership

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New Jersey Thoracic Society Membership Application

:

Trainee Documentation (attesting my status):

$50 Full Membership
Free Trainee - Fellow, Resident, Student
(Must present document attesting status)

 

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

Present Work Setting:
Institutional Practice
Private Practice
Research
Medical School Faculty
Retired
As an NJTS member, would you like to be on a list which we share with the public requesting a physician listing?
Yes   No  
As an NJTS member, please check which areas you would like to participate:
Advocacy (testify on legislation)
Advisor on Scientific Research
Education
NJTS Program Development

 

Section 3A: Physician 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 (Tb listed separately)
Interstitial Lung Disease
Lung Cancer/Oncology
Environmental/Occupational Medicine
Palliative Care Medicine
Pathology
Pediatrics/Neonatology
Pulmonary Hypertension
Radiology
Reactive Airway Disease
Sleep Medicine
Tobacco Advisory Group
Transplant Medicine
Tuberculosis
Other

If Other:

 

Section 3B: Respiratory Care Practitioner Information

The criteria for membership are certification as a Respiratory Care Practitioner in New Jersey and a minimum of one year as an RCP. (Experience does not have to be in NJ)
My expertise is in the following area(s):
Critical Care
Management
Pediatric/Neonatal Intensive Care
Education
Pulmonary Function Testing
Home Care
Other

If Other:

 

Section 3C: Nurse Information

The criteria for membership are an advanced degree in nursing and a minimum of one year experience in a respiratory nurse specialist area.
My expertise is in the following area(s):
Home Care
Critical Care
Long Term Care
Ambulatory Care (office, clinic practice)
Nursing Education
Adult Care
Public Health
Pediatrics
Other

If Other:

 

THE NEW JERSEY THORACIC SOCIETY

  • The New Jersey Thoracic Society (NJTS) is a non-profit professional and scientific society dedicated to pulmonary, critical care, and sleep medicine. Our mission is to further medical education, scientific collaboration, and to promote advocacy for issues relating to lung health in the state of New Jersey. We represent academic and community physicians, trainees in pulmonary and critical programs, and pulmonary allied health professionals.

 

Section 4: Application

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

 

 

CREDIT CARD PAYMENT

Credit Card First Name
Credit Card Last Name
 
Credit Card Number
CVV2 Security Code
Credit Card Expiration Date: