SALIS: Membership Information Form

2008 SALIS Membership Application Form

-- STEP 1: FILL OUT APPLICATION FORM ONLINE.

If you prefer, a print version of this form is available here and can be filled out by hand and mailed to SALIS along with your check.

Please select one: (required)

New membership
Renewing membership

I will be paying by: (required)

Check, cashier's check, or postal money order: fill out form below, click "Next Step," print out next page and mail copy to SALIS with payment in U.S. Dollars.

Credit Card: fill out form below, click "Next Step," and follow instructions for secure online payment with PayPal.

Section I - Contact Information

Check here if you are renewing membership and your contact info has not changed (Fill in Name and Email field only).

Member Name

Member Email

Name on Credit Card
(if different)

Email for Credit Card

Title

Organization

Address

City

State

Zip/Postal Code

Country

Phone

Fax

Web URL

Section II: Membership Information

Type of membership:

[Note: Cut-off date to receive Addiction Professional offer was February 1, 2008, so that option has been removed.]

I am interested in being active in the following Special Interest Group(s)/Committees:
Australian Special Interest Group
Canadian Special Interest Group
Multi-Cultural Special Interest Group
South East Asian Special Interest Group

Committees:
Education & Outreach
International Networking
Information Technology

Check here if your organization is designated a:
RADAR State Center
RADAR Specialty Center
RADAR International Center
RADAR Associate Center

Full members only, Check if you'd like to receive:
NIDA Monographs
NIAAA Monographs
Materials from NCADI
ONDCP publications