ISMR New Member Application


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Member Overview / Summary
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Membership ID:
Contact Email Address:
Affiliation:
Membership Classification:
Current Amount Due: $        
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Login Information
How did you hear about the ISMR?
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Contact Information
Title:
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Country: *
Address 1: *
Address 2:
City: *
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Email Address: *
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Affiliation Information
University / Institution / Affiliation / Private Practice:
Department:
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Education Information
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Professor?
Undergraduate School Attended:
Undergraduate Degree Completed on:
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Graduate School Attended:
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Are you currently enrolled in a full time recognized Prosthodontic training program?

Member Photos

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Member Registration Payments
Membership Dues for 2018

ISMR Donation Options:
Enter an optional donation amount
for one of the 2 funds
ISMR Donation Amount (Link to >> ISMR Donations Details coming soon)


Outreach Fellowship Donation Amount (Link to >> Outreach Fellowship Program Details coming soon)

Credit Card Information
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Payment History
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Donation History
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Make a Donation
Credit Card Information
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Donation Amount * $
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Card ID/CCV * (3 or 4 digit number on back of card)
Card Expires *
Name on Card * First: Last:
 



(Administrative Use Only!)
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Member Classification Change Request.
Fill out your comments below about why you wish to change. Click [Request Change] next to the Classification below that you wish to change to. The Membership Committee will review your request for consideration.
Comments:
 Classification
Constituent (Annual Dues: $245, Processing Fee: $75 , Includes Journal: No)
Constituent Members of the ISMR shall be those individuals who have completed a professional qualification in medicine, dentistry, rehabilitation medicine or allied healthcare professions with relationship to maxillofacial rehabilitation. Scientists with a demonstrated interest related to maxillofacial rehabilitation will also be eligible to be considered for membership.
Life-Member (Annual Dues: $0 , Includes Journal: No)
Life Members of the ISMR shall be those Constituent Members who apply for Life Membership, or are proposed by the Board of Councilors, and who have:
- Held memberships in the ISMR for at least ten consecutive years immediately prior to applying or being proposed and have attained the age of 65.
- Because of illness, retired from active participation in work related to maxillofacial prosthetics.

Life Members may not vote in ISMR business or elections and may not hold elective office.