There are many benefits to joining the CAOMS, such as excellent continuing education opportunities at our annual events, providing valuable input about issues that affect our specialty, and being part of a vibrant community of your peers. 1 2 3 4 5 6 Page 1 of 6 (0%) Member Information Membership Type * - Select -ActiveAffiliateSupportingStudentCAOMS Active + AAOMS Affiliate Active - 575.00 Affiliate - 275.00 Supporting - 275.00 Student - 0.00 CAOMS Active + AAOMS Affiliate - 1275.00 Name Prefix * - Select -Dr.Mr.Mrs.Ms. First Name * Middle Name Last Name * Job Title Gender FemaleMaleTransgender Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Upload Image Files must be less than 2 MB.Allowed file types: gif jpg png. Citizenship Place of Birth (City/Country) Preferred Language EnglishFrench Email * Email 2 Website Home Address Home - Street Address Home - Street Address Line 2 Home - City Home - State/Province Home - Country CanadaUnited States Home - Postal Code Home - Phone Number Office Address Office - Street Address * Office - Street Address Line 2 Office - City * Office - State/Province * Office - Postal Code * Office - Country * CanadaUnited States Office - Phone Number * Preferred Mailing Address * Office Home May we correspond via email exclusively? * Yes No Preferred Communication Method(s) Phone Email Postal Mail Privacy Preferences Do not email Do not phone Do not mail Do you want your profile to be public? * Yes No Are you a Diplomate of the AAOMS? Yes No Have you ever had your medical license suspended or revoked? Yes No If yes, please explain and provide documentation. Have you ever been convicted of a felony? Yes No If yes, please explain and provide documentation. Note: A felony conviction will not automatically bar membership. Present type of practice: Currently a Resident Practicing Oral and Maxillofacial Surgeon Procedures Anaesthesia Cleft Lip and Cleft Palate Cosmetic Facial Surgery Dental Implants Facial Trauma Jaw & Improper Bite Joint Disorders Obstructive Sleep Apnea Pathology & Reconstruction Surgery of the Oral Cavity & Wisdom Teeth Licence Upload Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf.