Cedars-Sinai Cancer - New Membership Application

Based on the Membership Criteria, please select the type of membership for which you are applying:

Please indicate your Academic Research program affiliation (includes laboratory based research as well as clinical research). Select "Non-Aligned" if you do not wish to be affiliated with an Academic Research program.

Please indicate your Primary and Secondary Clinical program affiliations. Select "Non-Aligned (Clinical)" if you do not wish to be affiliated with a Clinical program.

Please Note the following:
1) The academic research programs are likely to be "re-themed" in coming years as the Institute matures upon the advice from peer reviewers.
2) Affiliation with an academic research program requires active participation in the clinical or basic research (or both) of the program and sustained productivity.
3) Affiliation with up to 2 clinical programs does not interfere with conduct of clinical activities.

Please upload a Statement (maximum 1,500 words) which addresses:

• your interest in joining Cedars-Sinai Cancer;
• your cancer research focus or potential for collaborations with Cedars-Sinai Cancer members

Please upload your current NIH Biosketch based on the current NIH guidelines, which can be found: https://grants.nih.gov/grants/forms/biosketch.htm

Please upload a copy of your full Curriculum Vitae (standard Cedars-Sinai format, preferred). Highlight any publications that are cancer-related in yellow.

Please indicate your agreement with the Membership Criteria and your interest in joining the Cedars-Sinai Cancer by reading the Membership Agreement and clicking on the submit button below:

Cedars-Sinai Medical Center
CEDARS-SINAI CANCER

---------- MEMBERSHIP AGREEMENT ----------

1. Certifications. 
   By my signature below I hereby certify that I meet the eligibility requirements for the membership status checked above (as set forth in the Cedars-Sinai Cancer (CSC) Membership Criteria Policy (the "CSC Membership Policy")), that I will comply with all provisions of the CSC Membership Policy, including without limitation, those provisions related to membership responsibilities, resource access and assistance, application procedure, and membership review process, and that I agree to the terms and conditions set forth below.
   
   
2. Compliance.
   a) Physician Members Only: I certify that I am currently Board certified in my medical specialty, and am a member in good standing of Cedars-Sinai Medical Center's ("Medical Center's") Medical Staff with appropriate clinical privileges. I will comply with all applicable provisions of the Constitution and Rules and Regulations of Medical Center's Medical Staff.
   b) All Members and Enterprise Investigators: I will comply with California and federal law and all applicable policies and procedures of the Medical Center.
   
   
3. Conflict of Interest.
   I agree to comply with Medical Center's Conflict of Interest Policy, and to electronically complete and execute on an annual basis the Medical Center's Conflict of Interest questionnaire.
   
   
4. Independent Contractor.
   No employer-employee relationship is created by this Agreement or by my membership in the CSC. I am an independent contractor and as such shall have no claim under this Agreement or otherwise against Medical Center for vacation pay, sick leave, retirement benefits, social security, workers' compensation, disability, or unemployment insurance benefits, or employee benefits of any kind. Medical Center shall neither have nor exercise any control or direction over the manner in which I provide professional services provided that such services shall be in accordance with current and generally accepted medical practices.
   
   
5. Billing.
   Physician Members Only: I will be solely responsible for billing and collecting for all physician services I provide to patients unless I have previously entered into a separate agreement with Medical Center with respect to billing and collection for my physician services. All of my billing and collection activities shall be in compliance with applicable laws, customary professional practices, the Medicare and Medi-Cal programs, and other third-party payor programs, whether public or private. Medical Center shall be solely responsible for billing and collecting all facility fees related to the operation of the CSC. I will cooperate fully with Medical Center if any billing issues arise.
   
   
6. Term.
   This Agreement has an initial term of one (1) year commencing on the date hereof, and shall expire after the initial one (1) year term unless extended by mutual written agreement of the parties.
   
   
7. Termination.
   This Agreement may be terminated as follows:
   a) Medical Center may terminate this Agreement on fifteen (15) days prior written notice to me if I am in material breach of the performance of my duties as set forth in this Agreement or my failure to fulfill any of my certifications herein. 
   b) Medical Center may terminate this Agreement on fifteen (15) days prior written notice to me if I fails to comply with all provisions of the CSC Membership Policy.
   c) Either party may terminate this Agreement immediately upon written notice to the other party that the party providing notice has obtained advice from legal counsel that continuation of this Agreement could violate federal, state or local laws, regulations, or ordinances, or have a negative tax impact on Medical Center.
   d) Physician Members Only:  Medical Center may terminate this Agreement immediately upon written notice to me in the event that I have failed to maintain Medical Staff membership in good standing with appropriate clinical privileges and without restrictions. In such case, this Agreement terminates effective immediately upon delivery of such written notice.
   
   
8. Referral Laws.
   Nothing in this Agreement is intended or shall require either party to violate the California or federal prohibitions on payments for referrals. This Agreement does not create any obligation or requirement that I make referrals to Medical Center or that Medical Center refer patients to me. Nothing in this Agreement is intended to limit or restrict me from establishing staff privileges at, referring any service to, or otherwise generating any business for any other person or entity.
   
   
9. General Provisions.
   This Agreement sets forth the entire understanding of the parties and supersedes any and all prior oral or written understandings regarding the subject matter hereof. This Agreement shall be governed by and construed in accordance with the laws of the State of California. I may not assign my rights or delegate my duties under this Agreement without Medical Center's prior written approval. In the event of any proceeding related to this Agreement, the losing party shall pay the prevailing party's reasonable attorneys' fees and expenses incurred in any phase of the dispute.