Member Registration

Member Registration

This form is intended to be used for those that would like to register without registering to attend a meeting. If you want to register for a meeting, please use the form that can be found under the current meeting.

Registrant Information

First:

Last:

Email:

Rank:

Address:

Address (2):

Address (3):

City:

State:

Zip/Postal Code:

Phone:

School/Company:

National ASM Member?

National ASM Member #

Membership Fees

Membership Dues:
	Select all that apply
		I have already paid dues through National (enter $0 above)

Volunteer
		Please contact me about becoming a corporate sponsor.
		Please contact me about serving on the MI-ASM Board.
		I would like information about serving as a volunteer for MI Branch of ASM.

Special Needs/Comments?

Please make your check payable to MI-ASM and send to the following address with a printed copy of this form.

Alan P Hudson PhD
Dept Immunology and Microbiology
Wayne State University School of Medicine
Scott Hall, 540 East Canfield Avenue
Detroit, MI 48201

*Postdoctoral fellows are considered to be students.