Membership

New Membership Application

Please note that this membership application form is intended for new member applications only; if you wish to renew your existing membership please go to the membership renewal form (a discount applies for renewing members between Oct. 1- Jan. 31)

Membership Fees:

Full Individual membership:  US$ 210 or € 150
Joint Membership: US$ 150
Member in training: US$ 70 or € 50

Payment modalities:
Please note that this online application form is only for annual membership dues* as well as members paying by credit card (VISA, American Express and MasterCard are accepted).

All dues are payable in either US Dollars or Euros depending on the country of residence; fees of individuals living in a Euro Zone country are collected in Euros.

Members wishing to pay by cheque (not accepted in Euros) or bank transfer are requested to download and fax/e-mail the below PDF application form for new members.

*ISN offers the possibility to apply and pay for a multi-year membership whereby the membership will run uninterrupted for as many years as the applicant wishes.  Currently multi-year payment can only be accommodated through the downloadable application form.

All fields marked with * are mandatory

Personal Details
Salutation *: Prof. Dr. Ms. Mrs. Mr.
First Name *:
Middle Initial:
Last Name *:
Doctoral-Level: PhD. MD. Other:
Position:
Institution:
Address 1 *:
Address 2 :
Zip/Postal *:
City *:
State/Province:
Country *:
   
Please include country and city code for both telephone and fax field
Office Phone *:
Fax:
Email *:
Date of Birth: (Format:dd/mm/yyyy)
National / Speciality Society Affiliation:
   
Billing Address
Check this box if your billing address is the same as your personal address (if so, you do not need to fill in the address fields below)
Address 1 *:
Address 2 :
Zip/Postal *:
City *:
State/Province:
Country *:
Area of Activity * (Please check all that apply)
Administrator Ind/Corp Rep.
Allied Health Professional Retired
Basic Researcher Student
Clinical Researcher Teacher/Educator
Clinical Practitioner  
Other:

If so, please specify:
Professional Interest * (Please check all that apply)

    

Primary Practice Setting * (Please check all that apply)

    

Member Category (Please tick the appropiate option)

US$ 210
Euro 150

In this case, please provide ful name and contact details on the next page.


    

US$ 150

 
On a next page you will be asked to fill out the names and individual e-mails of the other group members so that a record is created for them. Please however do provide their full contact details and demographics via the Joint member Contact Details Form.



(you will be charged in Euro if you live in a Euro Zone Country)

Please send your documents here.

US$ 70
Euro 50



(you will be charged in Euro if you live in a Euro Zone Country)

US$ / Euro Please enter the amount you would like to donate in addition to your membership fees.

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