Application Forms



International Organization of Professional Surgical Assistants

Application Forms





Select Application Type:


Yellow Highlighted Fields Are Required Information



Part 1:


Present Country Location:
Name:
Address:
City State/Zip
Country Email
Home Phone Cell Phone
Name as it should appear on your Membership Certificate
Date of Birth Sex/Marital Status M F
Place of Birth Occupational Training



Part 2


Choose an Occupation first...
All uploaded files MUST be less than 2MB and in one of the following formats:
Documents: [ Word Document (.doc/.docx), Acrobat (.pdf) ]
Passport Size Photo [ Image (.jpg/.bmp, not a .pdf) ] must be 2x2, not 2x2 on 8.5x11
Name of Medical School
Medical School Documentation
Date of Graduation
Any Post Medical School
Advanced Training
Curriculum Vitae
(Resume)
Color Passport
Size Photo (2x2)
Payment (PayPal Reciept or copy of Check or Money Order)
Check or Money Order must be mailed to:
IOPSA - 26221 East Kettle Circle, Aurora, Colorado 80016-2020
All uploaded files MUST be less than 2MB and in one of the following formats:
Documents: [ Word Document (.doc/.docx), Acrobat (.pdf) ]
Passport Size Photo [ Image (.jpg/.bmp, not a .pdf) ] must be 2x2, not 2x2 on 8.5x11
Name of Surgical Assistant Training Program
Surgical Assistant Training Program Documentation
Color Passport
Size Photo (2x2)
Date of Graduation or Expected Graduation (if Student)
Payment (PayPal Reciept or copy of Check or Money Order)
Check or Money Order must be mailed to:
IOPSA - 26221 East Kettle Circle, Aurora, Colorado 80016-2020
Name of Corporate Sponsor
Type of Institution or Organization
Check or Money Order must be mailed to:
IOPSA - 26221 East Kettle Circle, Aurora, Colorado 80016-2020

Part 3


I acknowledge that the role and function of a surgical assistant is to assist the surgeon, in the performance of a surgical procedure. It is understood and acknowledged that certification and/or licensure as a surgical assistant and not licensed as a physician in the USA, does not allow for any independent performance of any medical or surgical procedures, within the United States of America or its territories.

- I agree to the above statement.

I certify that I understand all statements in this application and affirm all information contained in this application to be true and correct. I understand that any misrepresentation will result in rejection of this application. I agree to hold the International Organization of Professional Surgical Assistants free from damage or complaint, by reason of any action its directors, officers or agents may take in connection with this application, or failure of the IOPSA to issue membership to me.

- Enter your initials to Certify

Note: This application is designed to be submitted electronically.
          Do not print and mail, fax or email.

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American Board of Surgical Assistants


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