The Hip Society's 2022 Rothman-Ranawat Traveling Fellowship Application
By completing this application form, you agree to share with The Hip Society, its employees, volunteers, and agents, your personal and contact information. Please review The Hip Society's
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Your Last (Family, Surname) Name:
Your First (Given) Name:
Your date of birth:
as of January 1, 2022
(full years only):
Your headshot (100 MB maximum)
Read the criteria below carefully. All boxes must be checked in order to proceed and be considered eligible for the program. Please contact The Hip Society (firstname.lastname@example.org) with any questions.
I am a board-certified / board-eligible practiving orthopaedic surgeon in my country of residence/practice, with a minimum of 2 years of practice.
I have received specialty training in the field of hip surgery.
I am committed to the practice of hip surgery.
I am able to demonstrate documented interest in advancing hip surgery via publications, presentations, research.
I am able to be away from home/practice on a 4-5-week tour in March-April 2022, and I am able to obtain an entry visa(s) for the United States and Canada. (The Hip Society will provide a letter of invitation upon request to selected Fellows. The Hip Society will not assist with the visa application process.
I am fluent in spoken and written English.
I am not a previous Hip Society Rothman-Ranawat Traveling Fellow.
Please sign this Affidavit portion (use your mouse or other navigation device to sign).