Membership Application for 2027

Section 1. Personal Information

• First NameMILast NameTitle------BSMSPhDMDMD, PhDMD, MPh
• Affiliation (Department, Government, College or University)
• Street AddressAddress Line 2
  CityState / Province / Region
  Postal / Zip CodeCountryUnited StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosDemocratic Republic of the CongoRepublic of the CongoCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
• Work PhoneFax
• Email
• Expertise- Select -Drugs of AbuseImmunologyInfectious DiseasesMolecular MechanismsNeuroscienceNeurovirologyPharmacologyOtherIf other

Section 2. Membership Term

This application is for January to December 2027, whether you are joining or renewing.

•   January to December 2027

Section 3. Membership Status

New members joining the Society for the first time must either be sponsored by an existing Charter Member or forward supplemental documentation for review by the Membership Committee. Student/Trainee Members should also provide a letter from a Supervisor documenting their training status.

•   New Member
•   Renewing Member - no change in status
•   Renewing Member - change to a new status

Section 4. Membership Category

Membership in any category includes listing in the Membership Directory, addition to the SNIP mailing list, discounted registration at the annual meeting, and on-line access to the NeuroImmune Pharmacology and Therapeutics. Regular and Patron members have voting privileges.

•   Regular Member ($125, Complete CV if New member, Read more)
•   Student/Trainee Member ($60, Complete CV and Letter from Sponsor, Read more)
•   Affiliate Member ($100, Letter of Explanation, Read more)
•   Research Associate / Technical Staff ($100, Letter of Explanation, Read more)
•   Patron Member ($2,500 or more, Single payment-lifetime membership, Read more)

Section 5. Required Documents

If indicated, forward required documentation here, or email Prasanta Dash, PhD (pdash@unmc.edu).

• Curriculum Vitae (CV)

Click on the Submit Application button to a secure web page where you can verify your information and enter your payment information.