The Microcirculatory Society, Inc.

Off-Line Dues Payment Form

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Please print a "hardcopy" of this form, complete it, and then submit it by regular mail along with your check to:
Mary D. Frame, Ph.D.
MCS Treasurer
Dept. of Biomedical Engineering
HSC T18-030
State University of New York, Stony Brook
Stony Brook, NY 11794

Make your check payable to: "The Microcirculatory Society, Inc."

Please Check Your Membership Status

_________Regular Member, Dues ($105):
Payment includes $45 for dues and $60 for the Society's Journal, Microcirculation. (8-issues per year).

_________Associate Member, Dues ($105):
Payment includes $45 for dues and $60 for the Society's Journal, Microcirculation. (8-issues per year).

_________Emeritus Member, Dues (Free with no journal, or $60 with journal)
Remember to submit this form regardless of whether you want the journal.

_________Student Member, Dues ($10 with no journal, or $70 with journal):

Name and Degree:

Present Position or Title:

Mailing Address:

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Office Phone:

Lab Phone:

E-Mail:

FAX:

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