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Membership Form

Please note that the details on this form are not submitted via a secure server - if you wish to submit your details by post or fax, please Click here for the Paper Application form.

The fields marked with a * are required fields - please complete all of these as a minimum.
Name: (*)
Address: (*)
County / State: (*)
Post Code / ZIP code:
Country: (*)
Telephone: (*)
FAX:
E-mail: (*)
Date of Birth (*)
Membership Type applied for (Please tick only one) – Click here for the definitions and cost of each Category Type
Full Membership                  Associate Membership - Entry Level                  Full         
Title:
Function:
Profession:
Are you currently working in the menopause field?
No Yes
If yes, please describe briefly:
Experience in the menopause field (research, clinic, etc.):
Specific area of interest (osteoporosis, chronic disease, skin, etc.):
Other areas of interest:
Any other general affiliation (FIGO, etc.):
Proposers - must be current members of the International Menopause Society. (If you do not know any member of the International Menopause Society, on submission of this form, the Executive Director, Ms Lee Tomkins, will appoint two proposers.)
Proposer Number 1:
Proposer Number 2:
I wish to become a member of the International Menopause Society:
I understand that members are required to abide by the Society’s rules:
I am aware that this application form and CV are circulated among the Board members as part of the Society’s admission procedure:
On being informed in writing that my application has been approved, I will immediately settle the amount payable to confirm acceptance on my part of membership of the International Menopause Society:
I understand that this membership fee is payable annually:
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