NC-COT Membership Application Form

NC-COT Membership Application Form

Personal Information

Name
Name
Level of Training

General COT Questions

Have you completed, or are you currently enrolled in any of the following fellowships
Are you a Member of the American College of Surgeons?
Are you a Member of the NC Chapter of the American College of Surgeons?
Are you currently active in the field of trauma?
Have you been actively involved with the NC-COT?

COT Activity Questions **Hidden**

What special skills and/or areas of accomplishment do you bring to the work of the COT in any of the following areas?

COT Activity Questions

What special skills and/or areas of accomplishment do you bring to the work of the COT in any of the following areas?

Questionnaire

What special skills and/or areas of accomplishment do you bring to the work of the COT in any of the following area?
Have you taken the ATLS® Provider course?
Have you taken the ATLS® Instructor course?
Are you an ATLS® Course Director?
Does your hospital participate in the ACS Trauma Quality Improvement Project (TQIP)?
Have you used the COT prevention materials?
Are you involved in Stop the Bleed Training?
Is your hospital verified by ACS?
Have you taken the COT Disaster Management and Preparedness course?
Are you a member of the American Association for the Surgery of Trauma?
Are you a member of any other trauma-related organizations?
Are you willing to attend the quarterly NC-COT Meetings?