MESSM/ISSM Membership APPLICATION

This form can be used to apply for MESSM/ISSM membership. Your membership application will be reviewed within 7 working days and, if approved, you will become a member for 2014. At the end of each calender year, a tacit renewal of your membership is applicable, for which you will be invoiced in November of the running year.

All data submitted on this form will be processed on a Secure Server (SSL), which is owned and maintained by the company managing the ISSM Secretariat "Status Plus B.V." in The Netherlands. For more information please contact us by phone +31-75-6476372 or e-mail secretariat@issm.info.

On-line Membership Application Form - Step 1 of 3

 
Gender:  M   F    
Title (Prof., Dr., etc.):   
First name:   
Last name:   
Suffix (MD, PhD, etc.):   
Institution/organization:   
Department:   
Function:   
Cell phone:   
Skype name:   
Personal website/profile:   
E-mail 1 (main):   
E-mail 2 (alternative):   
 
Prefered mailing address:  work    home   
 
Work address:   
   
City:   
Province/State:   
Zip code:   
Country:  
Work phone:   
Extension:   
Work fax:   
Corporate website:   
 
Home address:   
   
City:   
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Home phone:   
  

Additional professional information


Percentage of professional activity devoted to sexual medicine: %
Professional degree:
Medical specialty:
Main publications:
On-line CV (link): http://

The ISSM office may request you to provide additional professional information by e-mail if you can/do not provide the information above.
 


MESSM/ISSM Membership 2014


MESSM/ISSM Membership is valid for one full calender year (January 1st to December 31st, 2014) and includes a subscription to the Journal of Sexual Medicine (monthly) and Sexual Medicine Reviews (quarterly). Further benefits to members are discounted author publication fees for publishing in ISSM's Open Access journal 'Sexual Medicine', registration fees for all MESSM/ISSM Meetings and Symposia and access to an active website and intranet for discussion among MESSM/ISSM members of vexing problems and cases (see ISSM website).

MESSM/ISSM membership fees are based on and will be charged in EURO's (click on the rates below for a real time conversion into USD). To determine applicable membership fees, the MESSM/ISSM applies the World Bank classification based on the gross national income (GNI) per capita, resulting in 3 different membership categories, which are: A - high income countries, B - middle income countries, and C - low income countries. For a full list see www.issm.info. When applying/renewing the applicable membership category and membership fee as described below will be automatically applied and calculated.


Membership Category Membership Fee
MESSM/ISSM Full Membership 2014 - Cat. A (high income countries)* EUR   140
MESSM/ISSM Full Membership 2014 - Cat. B (middle income countries)* EUR   100
MESSM/ISSM Full Membership 2014 - Cat. C (low income countries)* EUR   40
 

Donation to the Zorgniotti Foundation


The Zorgniotti Foundation was established in 1994 after Adrian Zorgniotti, founder and first President of the International Society for Impotence Research (ISIR) that is currently known as the International Society for Sexual Medicine. The mission of the Fund is to finance scholarships and grants for young researchers in the field of sexual dysfunction through its relationship with donors. The financial resources of the Foundation will be distributed for basic and clinical research in the field of sexual medicine, for training of professionals in the field of sexual medicine and for public education. The Zorgniotti Foundation is organized under the auspices of the ISSM Grants and Prizes committee and the ISSM Board of Directors. The ISSM would like to thank you in advance for your contribution to this important foundation.

Donation to Zorgniotti Foundation:  EUR  (Donation in EURO's, Click here for exchange rates)
 

Payment


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