SIIM - The Society for Imaging Informatics in Medicine : Become A Member

Become A Member

Please complete the online membership application form below as competely and thoroughly as possible. We request that you provide both your work and your home addresses so that we have a means to contact you if we experience problems in our mailings. A menu item is provided for you to select which address to use for SIIM mailings (JDI, SIIM News, annual meeting information and other membership information).

Also, please provide information on your current job, occupational setting, and medical specialty in the appropriate fields. This helps the society to design programs and materials to better reflect our membership profile.

The SIIM Membership Department would greatly appreciate it if you use initial caps only in your submission. Do not use all capital letters. Thanks!

Please Note: If you are a current SIIM member or a recent member, save time by renewing your membership instead of going through the new membership process. Click on "Login" in the header bar and then log in to the membership pages by entering your email address and your membership ID number. If you don't have your membership ID number readily available, click on "I have forgotten my password" to have your password emailed to you. You will then be able to log in, update your membership information and renew online.

Salutation:
*First Name:
Middle Name:
*Last Name:
Degree:
Sex:	Male: Female:
Work Title:
Work Department:
*Organization:
Work Address:
Work Suite:
Work City:
Work State:	...if Other:
Work Postal Code:
Work Country:	...if Other:
Home Address:
Home City:
Home State:	...if Other:
Home Postal Code:
Home Country:	...if Other:
*Mailing Address Preference for SIIM Mailings:	Work: Home:
*Phone:
Fax:
*Email:
*Occupation:	Physician Medical Physicist Technologist C-Level Admin/CEO/CFO/CIO/CMO Health Care Administrator PACS Administrator IT Director/Manager/Health Info Computer Scientist/Scientist/Researcher Resident/Student Engineer Educator Vendor/Consultant
*Specialty:	Radiology Cardiology Nuclear Medicine Oncology Information Systems Pathology Other ...if Other:
*Primary Occupational Setting:	University Hospital Military, VA or Govt Hospital Community Hospital Private Practice Corporate University/College (Non Hospital) Government (Non Hospital)
Interests: (Select all that apply)	PACS Administration PACS Implementation Connectivity, IT Infrastructure Workflow/Productivity Image Processing Image Compression Archive Integrity/Security Teleradiology/Image Distribution QA for Electronic Images Reading Room/Speech Recognition Image Enabled EMR Computer-Aided Diagnosis Computed Radiography Direct Digital Radiology TRIP Other ...if Other:

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