ISDS Membership Form - International Society for Disease Surveillance

Please provide the following information for your membership:

First Name*
Last Name*
E-mail*
Job Title
Department
Organization or Company*
Occupation Category (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Degrees (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Other Degree(s)
Street
City
State/Province
Zip/Postal Code
Country
Phone
Are you interested in joining an ISDS committee? (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Payment Type

First Name
Last Name
E-mail
Job Title
Department
Organization or Company
Occupation Category (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Degrees (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Other Degree(s)
Street
City
State/Province
Zip/Postal Code
Country
Phone
Are you interested in joining an ISDS committee? (Select all that apply by holding down ctrl on a PC or command on a Mac while selecting)
Payment Type

Fields marked with an asterisk (*) are required.

Once you click "save" you will be taken to a paypal payment page. If you wish to pay by check, please send a check for the appropriate amount ($50 regular and $35 student) payable to "ISDS" to the ISDS office at:

ISDS
26 Lincoln Street, Suite 3
Brighton, MA 02135

Please note your membership will not be active until we receive you payment in the mail or via paypal.