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Off-Line Application for Membership

(Please print a "hardcopy" of this form, complete it, and then submit it by FAX or regular mail)

Desired Membership Category (Check One)

_________Regular Membership:
Academic degree at the doctoral level and evidence of scientific achievement equivalent to at least 3 published papers in peer reviewed journals. The degree requirement may be waived in special circumstances at the discretion of the Membership Committee.

_________Associate Membership:
Academic degree at the doctoral level, but do not yet meet scientific achievement requirements for Regular Membership.

_________Student Membership:
Full-time graduate student with an interest in microcirculation research.

Applicant's Name:

Present Position:

Mailing Address:

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Office Phone:

FAX:

E-Mail:

Signatures of Nomination from two current Members of The Microcirculatory Society, Inc., must be submitted in support of this application. Have the two sponsors sign and print their names below.

Signature:

Print Name:

Sponsor 1:

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Sponsor 2:

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Applicant's Degree:

Year:

Institution:

1.

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2.

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Include Applicant's Scientific Achievements (Brief Biographical Sketch).
List three relevant publications in peer reviewed journals to support your application (include titles). Upon acceptance as a member of The Microcirculatory Society, Inc., all new members are required to pay their annual membership dues in a timely manner in order to maintain their membership.

Dues for Regular and Associate Members (except post-doctoral fellows) are $105 per year. Of that amount, $60 covers the member's cost of a subscription to the journal "MICROCIRCULATION" which includes a hardcopy of, and on-line access to, the journal. The remaining $45 is to help cover the Society's annual operational costs. Dues for Student Members and for post-doctoral fellow Associate Members are either $10 with no journal subscription, or $70 with a journal subscription and on-line access. The amount for dues was last voted upon by the membership at the April 12, 2003, Society Business Meeting, and published in the Summer, 2003, Society Newsletter.

Please send application and supporting materials to:

Anatoliy A. Gashev, M.D. Ph.D. Chair, Microcirculatory Society Membership Committee
Research Associate Professor,
MCS Membership Committee Chair,
College of Medicine
Texas A&M Health Science Center,
Temple, Texas 76504

Phone number: 254-742-7147
Fax number: 254-742-7145
e-mail: gashev@tamu.edu