Membership Checkout

Membership Information

You have selected the Affiliate Level 2 membership level.

This membership level is for Affiliate Members for organizations with 41 to 100 members, staff, faculty, etc.

The price for membership is $497.

Membership expires after 1 Year.

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Account Information

Username

Password

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First Name

Last Name

Email Address

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Contact Details

Institution

Department

Address

City

State/Province/Region

Zip Code/Postal Code

Country

Professional Details

Salutation

Degree(s)

Ex. MD, PhD, MBBS, MPH, RN, MSc, etc.

Profession

Organizational Overview

Organization Mission/Profile

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Organization Website

Please provide the link to your organization's website.

Year Founded

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Current Leadership

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

More Information

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Set your Membership up for Automatic Renewals (Optional)

Select the box & your credit card/PayPal account will be annually billed at $497/Year.

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Payment Information

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Expiration Date

CVC

Discount Code

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