IBRA FULL MEMBERSHIP APPLICATION FORM

Who is eligible for IBRA Full Membership

Any person with relevant qualifications and with interest in participating in all aspects of the IBRA
Community can be admitted as Member of the IBRA.

Requirements for IBRA Full Membership

Membership is open to professionals with an expressed interest in any facet of bone and soft tissue
surgery of the musculoskeletal system wishing to participate in the IBRA and abide by its principles
and obligations.

A new IBRA Member has to be nominated by a (1) current IBRA Member and supported by two (2)
current IBRA Members. All three are required to confirm the nomination and/or support by signing this
form or by submitting a signed supporting letter to the Administration Office. Further, a current CV in
English of the candidate must be submitted. Once the application is complete (signatures from
nominator and supporters and receipt of CV), it will be presented to the IBRA Board of Directors who
will review all nominations and decide on their acceptance. Board Meetings are held at least once
annually.

The annual Membership Fee is CHF 150 (Swiss Francs). Non-payment of Membership Fees for more
than 1 (one) year leads automatically to Basic Membership.

I herewith express my wish to become a Full Member of IBRA – International Bone Research
Association (please write clearly and in CAPITAL LETTERS):

First Name: ………………………………………………………….…………………………….

Last Name: ……………………………………….……………………………………………….

Title: ………………………………………….…………………………………………….

Spezialization: …………………………………………………….………………………………….

Preferred address: ☐ Home Address ☐ Working Address

☐ Home Address:
Street ……..……………..………………………………………….......…………………..

City / Zip Code / Country ……………..…………………………………………………………………………

☐ Working Address:

Hospital and Street …………………….…………………………………………..................................

City / Zip Code / Country …………….………………………………………………………………………....

Email Address: ………………………….…………………………………………………………….

Telephone: …....………………………………………………………………………………….

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Permission upcoming events**

Date and place: ……………………………… Signature:……………………………..

It is our wish to nominate and support ……………………………………………… for IBRA
Membership.

Nominator: ……………………………………………………………………….

Supporter 1: ……………………………………………………………………….

Supporter 2: ……………………………………………………………………….

We are sure he/she will be an active support to our association and sincerely hope that the IBRA
Board of Directors will support this nomination.

Signature – Nominator Signature – Supporter 1 Signature – Supporter 2

Date: Date: Date:

Please make sure that your full personal data is included in the form as
requested above, also in the CV which should be in English.

If all is complete, please email or fax the documents to the IBRA Administration
Office (Email: info@ibra.net or Fax No: +41 61 319 05 19)!

THANK YOU!

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