2008 IEIIS MEMBERSHIP AND InI SUBSCRIPTION FORM

Form for New and Renewing Members

To pay online, please complete this form and submit as instructed. Information submitted through this website is secure. (Click here for more information on the security of this site.)

Payment may also be made by submitting a copy of this form, along with check, money order, or credit card information, by mail to Kent Myers / IEIIS Treasurer / 553 Old Corvallis Road / Hamilton, MT 59840-3131 / USA, or by FAX to Nancy Pollman at +1 406 777 7270.

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First Name*	Middle Initial
Last Name (surname) *	Highest Degree(s)
Preferred Name
Phone Number*	Fax Number
Email Address* Information gathered through this site is considered private and is for the exclusive use of the IEIIS in conducting its internal business. Your information will not be shared with any Third Party without your express permission (see below). Click here to see the privacy policy of the company that manages the credit card transactions.
Institution/Department
Address Line 1*	Address Line 2
City*	State/Province*   Zip/Postal Code*
Country*
Membership Type IEIIS members are entitled to a reduced annual subscription rate for the Innate Immunity (InI), The Official Journal of the International Endotoxin and Innate Immunity Society (IEIIS). Subscription to the journal is optional with membership. Annual memberships and InI subscriptions expire December 31.
New   Renewing
Active, $60.00 US Active plus Journal subscription, $170.00 US Associate (non-voting), $60.00 US Associate (non-voting) plus Journal subscription, $170.00 US Emeritus (age 65 and over), $0.00 Emeritus (age 65 and over) plus Journal subscription, $114.00 US Student, $15.00 US Student plus Journal subscription, $125.00 US Non-member (Journal subscription only), $204.00 US Optional contributions: IEIIS fund, Amount Nowotny fund, Amount
Are you up-to-date on your dues? If not, please consider providing additional payment for any year(s) you may have missed.
Would you like to pay for additional years? Active and Associate members may pay for up to four additional years (i.e., through 2011) at the current rate of $60.00 USD per year. This is a convenient and economical way to ensure that you remain current on your membership dues. Please enter the additional years and the corresponding dues amount in the following boxes:
I am paying dues for:       Amount of additional dues:
Select the topic that most closely identifies your research interest: select one of the following: Chemistry and Biochemistry Immunology Microbiology Physiology, Pathology and Clinical Science Other Other:
Would you like to be considered for an elected or appointed office in the IEIIS?  yes  no
Are you changing the status of your membership (e.g., from Student to Active or from Active to Emeritus)? If you reply "yes," staff will contact you for further information.  yes  no
If you are a student or postdoctoral fellow, please include the name of your department chair or advisor.
Are you interested in receiving information about products or services of possible interest to those in the endotoxin and innate immunity fields?  yes  no
If you are a new member, please provide a statement or citation(s) for representative publication(s) which demonstrate your interest in innate immunity or endotoxin-related research.
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Questions about Membership?

Email: Membership@ieiis.org

Questions about Payment Options?

Email: Treasurer@IEIIS.org