Membership Checkout

Membership Information

You have selected the Affiliate Level 3 membership level.

This membership level is for Affiliate Members for organizations with 40 members, staff, faculty, etc. or less.

The price for membership is $397.

Membership expires after 1 Year.

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Account Information

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Password

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First Name

Last Name

Email Address

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Area(s) of Interest

List some of your areas of interest (ex. Mass Gathering Medicine, Emergency Medicine, Public Health, Nursing, etc.).

- LinkedIn Page

- ResearchGate Page

- YouTube Page

- X Page

Please include the web address (URL) to your X page, not your X handle.

- Webpage/Blog

Professional or personal webpage or blog

Contact Details

Institution

Department

Address

City

State/Province/Region

Zip Code/Postal Code

Country

Organizational Overview

Organization Mission/Profile

Please provide your organization's mission

Organization Website

Please provide the link to your organization's website.

Year Founded

What year was your organization founded?

Current Leadership

Please provide the name of your organization's current Chair, President, or Executive Director.

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How did you hear about WADEM?

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Select the box & your credit card/PayPal account will be annually billed at $397/Year.

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Expiration Date

CVC

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