Active Member Aug 1, 2019 Active members are physicians (MD, DO, DPM) who dedicate at least a portion of their practice to Orthopedic Medicine. Terms: $400 / Year First Name:* First Name Required Last Name:* Last Name Required Gender:* Gender is Required Male Female Organization:* Organization is Required Office Phone:* Office Phone is Required Mobile Phone:* Mobile Phone is Required Org. Street :* Org. Street is Required Org. City, State, Zip:* Org. City, State, Zip is Required Website:* Website is Required Email Contact :* Email Contact is Required Practice Specialization :* Practice Specialization is Required Physical Medicine & Rehabilitation Family Medicine Sports Medicine Interventional Pain Orthopedics Podiatry Other Degree(s):* Degree(s) is Required MD DO DPM PhD Fellow Other Principal Practice Setting:* Principal Practice Setting is Required Single Specialty Group Hospital Academic Hospital Community Research Military Multispecialty Group Solo Provider Organization Size:* Organization Size is Required Physician's State Lic#:* Physician's State Lic# is Required NPI# : NPI# is not valid How did you hear about IOF?:* How did you hear about IOF? is Required I hereby consent to the release by any hospital, educational institution, governmental agency, physician, professional society, or other person posessing or requiring the same whether or not listed above, of any and all information in any way pertaining to my personal character, training, experience, or professional competence. I hereby release from any liability the Interventional Orthobiologics Foundation and any and all individuals for their acts performed in good faith in connection with evaluating my application and my credentials and qualifications. I hereby certify that all information recorded on this application and any attached documents are accurate and support my qualifications for membership in the Interventional Orthobiologics Foundation for which I now apply. I hereby agree that Interventional Orthobiologics Foundation may verify any of the above data. I hereby understand that my payment today is non-refundable, to cover processing fees and immediate initiation of membership. Note: This membership renews automatically at the end of one year for an additional year, every year, unless terminated by member or IOF. Member may cancel at anytime.* Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Have a coupon? Coupon Code: Invalid Coupon Pay with Credit Card First Name on Card Last Name on Card Zip code for Card Credit Card Number Invalid Credit Card Number Expiration Invalid Expiration CVC Invalid CVC Code Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it. Sign Up for the Interventional Orthobiologics Foundation Newsletter We Respect Your Privacy No val Please fix the errors above