ISNIM - Joining The ISNIM - Membership Renewal

Instructions

The Membership Renewal form may either be printed and mailed, or sent electronically. To complete this form, fill out your personal information, membership level, billing information, and provide a signature.

Personal Information

Name: (First, Middle & Last)
Degrees:
Title:
Department:
Institution:
Street Address:
Address Line 2:
City:
State or Province:
Zip or Mail Code:
Country:
Telephone:
Fax:
Email:
Scientific Focus:

Membership Categories

Remittance:

	Regular Membership, 3 Years (Includes E-Journal Access)	$350
	Premium Membership, 3 Years (Includes E-Journal Access & Paper Copy)	$415
	Regular Membership, 1 Year (Includes E-Journal Access)	$125
	Premium Membership, 1 Year (Includes E-Journal Access & Paper Copy)	$147
	Membership only, 1 Year (No Journal Access)	$75
	Retiree Membership, 1 Year (Options: E-Journal: Add $50.00; E-Journal & Paper Copy: Add $72)	$35
	Student/Post Doc Membership, 1 Year (Options: E-Journal: Add $50.00; E-Journal & Paper Copy: Add $72)	$35

Billing Information

Payment Method:	If paying by check, make the check in U.S. dollars payable to "ISNIM" and send to the Executive Director.
If you print this form and are paying by Credit Card, complete the following:
Credit Card Type:
Name on Credit Card:
Credit Card Number:
Expiration Date (MM/YY):
Total Amount Charged:	$

Signature

Electronic Signature: If you are submitting this form electronically, please provide an electronic signature by typing your name in the box below.

Print Signature: If you are printing this form, please sign and date the form below.

Signature: _____________________________________________ Date: ________________

-OR-

If Paying By Check:

Please mail the completed form and a check in USD made payable to "ISNIM" to:

Jeannine A. Majde-Cottrell, Ph.D.
Executive Director, ISNIM
P.O. Box 41269
Arlington, VA 22204-8269, USA

General

Membership

Information