Young Microsurgeons Group Application Question Title 1. Contact Information Name Institution Address City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title 2. What year did you start practicing after formal training? Question Title 3. What year did you become board certified (if applicable) Question Title 4. If you are not board certified, when is your intended certification date? Question Title 5. Are you interested in serving on committees? Yes No Comment Done