 International Society for Maxillofacial Rehabilitation |
Membership
Application
Annual Dues Payment
ISMR members pay annual dues of $185/year.
Includes annual subscription (6 issues) to the International Journal of Prosthodontics.
Contents
 | Personal Details |
| Professional Background |
| Membership Payment |
Return to ISMR Home Page
New Member applicants and current ISMR members may complete and submit the following membership fee form.
| Personal Details |
- Surname (Family Name):
- First Name (Given Name):
- Degrees:
- Fill in the address you would like to receive your mail and journal.
University (if applicable)
Department (if applicable)
Street Suite/Room City State/Province Country Zip/Postal Code Telephone (include country/city code) Fax (include country/city code) E Mail
SoloGroupAffiliateEmployeeGovernmentDental School
| Professional Background |
- Professional degrees:
- Other qualifications:
- Membership and Affiliations:
| Membership Payment |
$185 / annually - Includes subscription to The International Journal of Prosthodontics (IJP) - 6 issues per year. Your IJP subscription will begin upon receipt of annual dues.
If you are already receiving this journal, and do not wish to receive another,
you may deduct $85 from your annual dues.Form of payment accepted:
Check/Money Order - issued in USA dollars, Payable to: ISMR
Credit Card - Visa or Master Card (only)
I am paying my dues with:
Check (Payable to: ISMR - Mail to: ISMR, P.O. Box 99119, San Diego, CA. 92169-1119
Credit Card (Visa or MasterCard, only)
If paying with a credit card, complete information below:
Credit Card Fee Payment:
Today's Date: Apply my dues for the year of:
Credit Card Number:
Card Expiration Date:
Thank you for your consideration to join the
ISMR.
After completing the above application, click "Submit Form".
| ISMR Administrative Office |
Email Address: [email protected]
RES, Inc � 4425 Cass Street, Suite A � P.O. Box 99119 � San Diego, CA 92169-1119
| Web Address | Office phone | FAX number |
| http://www.res-inc.com | 1 (858) 272-6560 | 1 (858) 272-7687 |
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