Indian MSS

Membership Form

Note : * Mandatory fields

Please keep a digital copy ready of all attachment before submission

PERSONAL INFORMATIONS

All files should not be exceed 10 MB

Full Name *

Gender *

Age *

Date Of Birth *

Email *

Contact Number *

Nationality *

(Indian / Overseas (As per current passport / Aadhaar card)- Attach proof)

Office Address *

City *

State / Province *

Country *

Pin / ZIP Code *

Phone Number *

Fax

Home Address *

City *

State / Province *

Country *

Pincode *

Phone Number *

Fax

Upload your photo *

QUALIFICATION & AFFILIATIONS

Qualification *

Affiliation/Position Held *

Name of the Institution *

Place of Work *

NMC / INDIAN STATE / OVERSEAS REGISTRATION

Registration No *

Council *

Date *

RESIDENCY

MD/DMRD/ DNB/Equivalent: Duration *

Institution *

FELLOWSHIP IN MSK RADIOLOGY

Institute / Centre

Fellowship Duration

Have you attended annual conference / mid-term conference of MSS, India

No of Annual Conference

No of Mid-term Conference

PUBLICATIONS IN MSK RADIOLOGY

a. No. of original research/Review article/Meta-analysis as Ist / IInd /Corresponding author

b. No. of original research/Review article/Meta-analysis as IIIrd author onwards

c. No. of Case report / Case series/ Pictorial review/ Letter to editor

ORAL PAPER / POSTER PRESENTATION / INVITED FACULTY LECTURE

a. No. of Invited Faculty lecture in reputed national (IRIA / MSS)/ international conferences(ISS, ESSR, AMS, AMSIG, RSNA, ECR) of MSK Radiology

b. No. of Oral paper of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) of MSK Radiology

c. No. of Oral paper of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as third author onwards

d. No. of Poster of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as First / Second author

e. No. of Poster of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as third author onwards

f. No. of Oral paper of MSK Radiology in state conferences as first / second author

g. No. of Poster of MSK Radiology in state conferences as first / second author

Letter of reference from two life members of MSS, India

MSS member Name & membership Number : 1 *

MSS member Name & membership Number : 2 *

ALL ATTACHMENTS

Copy of NMC / state / Overseas registration.

Proof of fellowship in MSK Radiology.

Proof of attendance in annual / mid term conference of MSS, India.

Proof of publications.

Proof of Oral Paper/ Poster presentation/ Invited faculty lecture.

Letter of reference from two life members of MSS, India. * Proforma of Letter of reference

Proof of Post training experience in MSK Radiology. *

Proof of percentage of routine MSK Radiology work. *

Proof of significant contribution in the field of MSK Radiology. *

Proof of significant contribution to MSS, India. *

Any other achievement.

Signature *

Date *

Place *

“I declare that the Information provided above are true to my belief and knowledge. If accepted for the membership, Ihereby agree to abide by the Constitution and Bye-laws of the Musculoskeletal Society. Any false declaration, or information will lead to cancellation of my membership without claim of my membership fee and liable to debar me from further applying for the membership of MSS, India for 10 years.”

Annexure : 1 Annexure : 2

Annexure : 1

Minimum Essential Criteria		Scoring
MSK Radiology fellowship from a reputed institute/ centre. (Observership / Online course will not be considered as fellowship) (Max. 10 Marks)	1-year MSK Radiology fellow >6 months but < 1year MSK Radiology fellowship	10 7
Attendance of MSS conference (Max. 10 Marks)	1 annual conference 1 mid-term conference	5 each 3 each
Publications (Max. 10 Marks)	Original research / Review article/ Meta-analysis in MSK Radiology as First / Second / Corresponding author Original research / Review article/ Meta-analysis in MSK Radiology as co-author (third name onwards) Case report / letter to editor / any other	4 each 2 each 1 each
Paper/ Poster presentation/ Invited faculty lecture (Max. 10 Marks)	Invited Faculty lecture in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) of MSK Radiology Oral paper of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as First / Second author. Oral paper of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as third author onwards. Poster of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as First / Second author Poster of MSK Radiology in reputed national (IRIA / MSS)/ international conferences (ISS, ESSR, AMS, AMSIG, RSNA, ECR) as third author onwards. Oral paper of MSK Radiology state conferences as first / second author. e-Poster of MSK Radiology state conferences as first / second author	4 each 3 each 2 each 1.5 each 1 each 1 each 0.5 each
Letter of reference (Mandatory Criteria)	Two Life members	15

“The applicant having score of 45 will be forwarded to the credential committee for consideration of MSS, India membership”

OVERSEAS MEMBERSHIP : The applicant having
1. Overseas nationality (current passport), or
2. Overseas registration with practicing in overseas, or
3. Both

INDIAN MEMBERSHIP : The applicant having
1. Indian nationality (Current Indian passport / Aadhaar card)
2. Registration in NMC/ state medical council.
3. Practicing in India.

(If all three criteria met, then only the applicant will be considered for Indian membership)

Proforma of Letter of reference

Membership Form

Membership Form

PERSONAL INFORMATIONS

All files should not be exceed 10 MB

QUALIFICATION & AFFILIATIONS

NMC / INDIAN STATE / OVERSEAS REGISTRATION

RESIDENCY

FELLOWSHIP IN MSK RADIOLOGY

Have you attended annual conference / mid-term conference of MSS, India

PUBLICATIONS IN MSK RADIOLOGY

ORAL PAPER / POSTER PRESENTATION / INVITED FACULTY LECTURE

Letter of reference from two life members of MSS, India

ALL ATTACHMENTS

Annexure : 1

“The applicant having score of 45 will be forwarded to the credential committee for consideration of MSS, India membership”

(If all three criteria met, then only the applicant will be considered for Indian membership)

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