Membership Application Form

Christian Society of Otolaryngology Head and Neck Surgeons
Application for Admission to Membership

Upon the recommendation of, a member of the Christian Society of Otolaryngology - Head and Neck Surgeons (the "Society"), the following individual has submitted an application to the Members of the Society for their approval.

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Work Contact Information:

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Home Contact Information:

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Spouse Name

Education Information:



Degree Awarded*

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Practice Information:

Description & Location of Practice*

Statement of Faith

The Statement of Faith of the Society is as follows: As Members of the Society, we believe in the following:

The one God, the sovereign Creator and Sustainer of all things. The one God who is Triune in the Father, the Son and the Holy Spirit.

We believe in the loving Father of the universe, who so loved the world that He gave His life in His Son, through Whose death and resurrection those who place their faith in Him might live eternally.

We believe in the unique deity and manhood of our Lord Jesus Christ, who is God incarnate, and has by death on the cross redeemed and saved those from sin and its penalty, who believe by faith and receive Him as Savior.

We believe in God's powerful and loving omnipresence as the Holy Spirit, on Whom we may rely to guide, comfort and teach us all necessary things, that we might live fruitful lives. In Him we live and move and have our being; and

We believe in the divine inspiration, integrity and [mal authority of the Bible as the Word of God and the ultimate rule of faith and practice.

The undersigned hereby certifies that he or she personally believes in the Society's Statement of Faith, as stated on the reverse side and that they will abide by the provisions of the Certificate of Incorporation and the By-Laws of the Society.

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