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 use the application form from the link on the right.

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: (*)
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:

Please enter the code below:

To become a member of the International Menopause Society, please complete the application form. Application for membership implies that you accept the objectives of the Society.

To comply with the Society’s By-laws, membership can only be granted after I have received your application form. Your application will be circulated to the Board of the Society. If your application is approved by the Board, you will be notified of your acceptance as a member and will receive information on how to pay your membership fee to the Society.

The annual fee for membership is US$175, which includes a subscription, at the special members’ rate, to the Society’s Official Journal, Climacteric. The journal is published six times per year. Please do not hesitate to contact me if you have any queries. I look forward to receiving your completed application form.

Yours sincerely,

Ms Lee Tomkins
Executive Director

If you wish to submit your details by post or FAX, please use this application form.

Paper Membership Application Form