CANDIDATE EVALUATION FORM
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* Last Name
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I would like to be considered for a faculty position to teach Lipoplasty of the:
Head & Neck
Arms
Gymeomastia
Abdomen and Planks
Calves and Ankles
Local Anesthesia
Mega Session
Tumescent Technique
Other Topic
I would like to be a Diplomate at the Lipoplasty University
I have at least 25 CME credit hours in Lipoplasty
I was a member of the Lipoplasty Society of North America
I would like to be a Graduate Student of the Lipoplasty University
I would like to be a Provost for (Country)of the Lipoplasty University
I would like to receive a copy of the book, Liposuction (From Head To Toe), so that my patients can learn about safe liposuction while in my reception area.
I am not currently doing liposuction, but would like to receive your newsletters and may be interest in the future.
   
 
   

Sponsorship Application: There is a $250 application fee for consideration as a graduate student or Diplomate. (This application fee will be waived this year only to previous members of the Lipoplasty Society of North America.) Board certified plastic surgeons from other countries are eligible to be graduate students and Diplomates of the Lipoplasty University. The verification of credentials is the responsibility of the provost appointed for each country and applicants must be in good status of ISAPS.

Annual Sponsorship Dues: To become a founding sponsor of the Lipoplasty University (Without Borders) the annual membership dues are $500. Immediately upon receiving your paid sponsorship, we will forward your Sponsorship Certificate, your copy of Liposuction (From Head To Toe), and password to the Sponsors Only section of our website. LU will advise you of upcoming advanced training seminars by email and through the membership website, LipoplastyUniversity.com.

Thank You
5750 Balcones Drive, Suite 201, Austin, TX 78731
Phone: 1-877-547-6362Fax: 1-512-873-7423