Friend of ISHA Application Form

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Personal Information

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First Name:

Middle Name:

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Photo:

Biography

Applicant Bio:

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Business Contact Information

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When providing your telephone number, please use the international format, including country code (Example: +1-541-754-3010).

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Private / Home Contact Information

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When providing your telephone number, please use the international format, including country code (Example: +1-541-754-3010).

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Administrator / Billing Contact

Administrator / Billing Contact First Name:

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Social Media Information

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Data Processing Consent

I give consent for ISHA to store and process my data for activities relating to my status as Friend of ISHA.

I withdraw consent for ISHA to store and process my data for activities relating to my status as Friend of ISHA. By withdrawing consent, I recognise that ISHA will be unable to fulfil my Friend of ISHA obligations and my status as Friend of ISHA will be terminated with immediate effect.

Friend of ISHA Acceptance Terms and Conditions

ISHA take the care of your personal information very seriously. The personal information you provide may be used to provide you with relevant news, and information relating to ISHA activities which may be of interest to you, some of which may be of a marketing nature.

ISHA ensure that your personal data is only shared with our membership management data processors, and will not be passed to any other external company. Your Personal Information will be held securely and in confidence. Your personal data may be transferred to a jurisdiction other than your country of residence.

If you agree that the information you provide may be used in this way, it will be governed by ISHA's Privacy Policy, available on the ISHA website at ishasoc.net.

Please indicate your acceptance or not of these marketing privacy consents below.

To stop receiving communications, please follow the “unsubscribe” instructions on the latest email you receive from us. To withdraw consent or to enquire what personal information we hold about you, email us at member@ishasoc.org.

"ISHA - The Hip Preservation Society (the Society) agrees 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."

Consent for personal information to appear in Member Area

Acceptance of Confidentiality T&Cs

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