ISSWSH Membership APPLICATION

This form can be used to apply for ISSWSH membership. Your membership application will be reviewed by the Board and if approved, you will become a member for 2017. At the end of each calendar year, a tacit renewal of your membership is applicable, for which you will be invoiced at the end of the running year.

All data submitted on this form will be processed on a Secure Server (SSL), which is owned and maintained by ISSWSH Association Management Company "Status Plus". For more information please contact us by phone +1 (952) 683 9025 or e-mail info@isswsh.org.

On-line Membership Application Form - Step 1 of 3

 
Gender:  M   F    
First name:   *
Middle name:   
Last name:   *
Degrees (MD, PhD, etc.):   
Institution/organization:   *
Department:   
Cell phone:   
Skype name:   
Date of birth:   
Personal website/profile:   
On-line CV (link):http://
A CV/Resume is required when applying for ISSWSH membership. If you have not provided an online link to your CV/Resume, please email it to info@isswsh.org or someone from our office will be reaching out to you to provide this

Please provide a brief statement of your interest in Women's Sexual Health:
 *
E-mail 1 (main):   *
E-mail 2 (alternative):   
 
Prefered mailing address:  office    home   *
 
Office address:   *
   *
City:   *
Province/State:   
Zip code:   *
Country:   *
Work phone:   
Extension:   
Work fax:   
Corporate website:   
 
Home address:   *
   *
City:   *
Province/State:   
Zip code:   *
Country:  
Home phone:   

ISSWSH Membership 2017


ISSWSH Membership is valid for one full calender year (January 1st to December 31st, 2017). More information about the different membership benefits and categories can be found here.

Membership Category Membership Fee
ISSWSH Active Physician Membership 2017 $   275
ISSWSH Active Non-Physician Membership 2017 $   150
ISSWSH Affiliate Membership 2017 $   400
ISSWSH Active Physician Membership + ISSM Membership (JSM/SMR) 2017* $   400
ISSWSH Active Non-Physician Membership + ISSM Membership (JSM/SMR) 2017* $   275
ISSWSH Affiliate Membership + ISSM Membership (JSM/SMR) 2017* $   525
 

ISSM Membership & JSM/SMR Subscription


If you are applying for ISSWSH membership including ISSM membership, an online subscription to the Journal of Sexual Medicine (monthly) and Sexual Medicine Reviews (quarterly) is included. With this subscription you have full online (digital) access to all journal articles. For a small additional fee of USD 25 you can also subscribe to receiving the printed copies of both journals. You can indicate your choice below:

Journal Subscription:  

Online access to JSM+SMR (NO EXTRA CHARGES)   
Printed copies + online access to JSM+SMR (+USD 25)   
 

Payment


I will pay by:  

Credit Card (preferred)  
Check   

Your comments/remarks: