Chapter Membership

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Ohio Thoracic Society Membership Application


Free Active Membership


Section 1: Demographic Information

Last Name
First Name
Middle Name
Present Position
Zip Code
Daytime Telephone
Fax Number
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

Please check as many areas as you are willing to serve in an advisory capacity.
Adult Asthma
Pediatric Lung Disease
Chronic Lung Disease
Environmental/Occupational Health
Home Health
Sleep Apnea
Within that advisory group, in which areas would you feel comfortable being called upon?
Advocacy (testify on legislation)
Public relations (speak to media)
Education of medical profession (conferences, grand rounds, etc.)
Education of lay audiences (patient ed. programs, support groups, etc.)
Assist in evaluating, revising, promoting education pieces
Submit articles for publication in newsletter
Are you interested in serving on the OTS Executive Committee?
Yes   No  


Section 3A: Physician Information

Please indicate any areas in which you have special interest or expertise.
Cardiovascular Disease
Chronic Lung Disease
Critical Care
Cystic Fibrosis
Infectious Diseases
Internal Medicine
Interstitial Lung Disease
Lung Cancer/Oncology
Occupational Medicine
Reactive Airway Disease
Sleep Apnea

If Other:
Present Work Setting:
Institutional Practice
Private Practice
Medical School Faculty
As a OTS member, would you like to be on a list which we share with the public requesting a physician listing?
Yes   No  


Section 3B: Nurse Information

The criteria for membership is an advanced degree in nursing with an interest in the prevention and management of respiratory conditions or an RN with 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

If Other:


Section 3C: Respiratory Care Practitioner Information

The criteria for membership is Certified Respiratory Care Practitioner in the state of Ohio with at least three years full-time experience as an RCP. (Experience does not have to be in Ohio)
My expertise is in the following area(s):
Critical Care
Pediatric/Neonatal Intensive Care
Pulmonary Function Testing
Home Care

If Other:



The Ohio Thoracic Society (OTS) is a professional organization dedicated to all aspects of lung disease, with special attention given to research, professional education for pulmonary critical care academic and community, physician pulmonary critical trainees and pulmonary allied health professionals (e.g. Nurses and respiratory therapists) and clinical practice.

The functions of the Ohio Thoracic Society are:
  • to disseminate the latest information regarding the diagnosis and treatment of pulmonary diseases
  • to expose physicians to a variety of topics related to pulmonary health care
  • to encourage the highest standards for training in pulmonary medicine and clinical practice
  • to foster knowledge exchange and open discussion among the local pulmonary community
  • to facilitate research within the region and interpretation of new scientific research


Section 4: Application

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