REGISTRATION FORM

For the American Board of Facial Plastic and Reconstructive Program on Maintenance of Certification in Facial Plastic and Reconstructive Surgery® (MOC in FPRS℠)

Instructions: To renew your ABFPRS certification, first register your intent to participate in MOC in FPRS®. From the date of registration, you have three years to complete all program requirements, including submitting the MOC in FPRS® application.

A full description of the program is provided in the Maintenance of Certification in Facial Plastic and Reconstructive Surgery® Information Booklet (PDF) and Application Form (PDF). If you have questions about the program or the status of your certificate, please call (703) 549-3223.

Registration Date Intended Application Date:

Name of Person Registering:

Address:
Adress:

City: State: Zip:

Cell Phone Number: Email Address:

I intend to participate in FACEforwardI intend to sit the proctored written and oral examinationI am applying for the ADMINISTRATIVE designationI am applying for the NON-SURGICAL designation

Intended Examination Date or FACEforward Starting Date:
required format: mm/dd/yyyy

Check the module you plan to complete: CosmeticReconstructiveCombination
Changes to module or FACEforward/exam selection must be requested no later than 6 weeks prior to exam.

Payment
I have already paid my dues for this year.I will pay my dues online, to be applied to my MOC in FPRS® feesI will mail my $295 dues payment, payable to ABFPRS, to be applied to my MOC in FPRS® fees

Diplomate Resources

The ABFPRS offers its diplomates a number of resources including:
  • Verifying certification
  • Framed certificates
  • Patient education flyers
  • AMA guidelines for ethical advertising
  • ABFPRS guest examiner
  • ABFPRS committee

Contact Us

Address:
115C South St. Asaph Street Alexandria, VA 22314
Phone:
(703) 549-3223
Fax:
(703) 549-3357
Email: