3 most recent Practice Appointments
Year to Year Place
Current Practice Setting
Number of Cases/Year
Academic Affiliation
Hospital Affiliation
N.B. If Membership is accepted, the following details will appear on the web site as part of the Membership List, accessible to ISHA Members only:
Full name, Country of work, City/town of work, contact email address
Are you happy for this information to appear on the web site? (Please select one) Yes No
Confidentiality Clause-Agreement of Confidentiality
"The International Society for Hip Arthroscopy has agreed to treat the entire contents of this application, including all inquiries or investigations made pursuant thereto and all fruits thereof as privileged and confidential materials not subject to publication, dissemination or private or in camera inspection. In consideration of that Confidentiality Agreement I make the following agreement. I specifically authorise the Society to make whatever inquiries and investigations it deems necessary to ascertain and verify my qualifications, credentials, professional standing and moral or ethical character. I further covenant and agree that I will not seek or cause to attempt to seek or cause any disclosure of production, whether private, public or in camera of the contents of any application file of any candidate for membership in the Society of whatever classification, including proceedings of the Board or any Committee pursuant thereto, or the products, fruits, or sources of any inquiries or investigations made pursuant hereto whether said disclosure be by operation or process of law or otherwise. Processing and consideration of the application will involve participation by numerous members of the Society on behalf of the Society; all activities concerning such processing and consideration shall not be considered to be a disclosure, production, inspection, nor dissemination by the members of the Society participating therein. In further consideration of the Society's processing and consideration of this application, I specifically covenant and agree that I will not commence, bring or institute any proceedings, suit or action in any court or other tribunal or forum directed against or to the Society or any member thereof in any way concerning, pertaining to or arising out of the consideration, processing, rejection, deferment, acceptance or other handling of this application for membership in the Society or any of the inquiries or investigations conducted in connection therewith."