Membership Application

If you prefer returning your application by fax, please download the application form here and send it to +49 (0) 4241 93 32 65.

Additional information on membership categories and fees

Membership category you are applying for *
 Active  Resident
 Associate  Corporate

First Name: *
Last Name: *
Date of birth: *
Address type: *
 Work address  Home address
Address: *
Zip: *
City: *
Country: *
E-Mail: *


Undergraduate: *
Degree: *
Year completed: *
Medical or Graduate School: *
Degree: *
Year completed: *
Other specialty training:
Year completed:
Post-Dermatology Residency Fellowship
(if applicable):
Year completed:

Are you currently practicing chemical peels with your practice or clinic full time? *  yes  no
If yes, please indicate the type of practice:  Solo  Clinic  Group  other


Please list names of two members or the International Peeling Society from whom the Membership Committee may request letters of endorsement:

IPS Member Endorser 1:
IPS Member Endorser 2:
 Endorsers are needed. Please contact me.

Board-certified Fellows of the American Academy of Dermatology are not required to submit 2 recommendations.

 Yes, I am a Fellow Member of the American Academy of Dermatology (AAD)

Professional Information

Please upload all relevant documents (diploma, certificates etc) relating to your membership application as pdf file (not for AAD members).

Select files...

Residents: please download and complete resident proof of status in its entry. Submission is obligatory.

 Yes, I want to become a member of the International Peeling Society *
 I have read and accept the bylaws of the International Peeling Society *
 Herewith I affirm that all above information submitted is complete and correct *

* mandatory fields   


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