IEIIS Membership Form

Form for New and Renewing Members

To pay online, please complete this form and submit as instructed. Online payments accepted are:
PayPal, check, money order

Payment may also be made with check or money order (USD) by submitting a copy of this form, along with payment, to the IEIIS Treasurer by mail to:

Alison Scott, IEIIS Treasurer
Dept Microbial Pathogenesis
Univ of Maryland, Baltimore
650 W Baltimore St, 8
South Baltimore, MD 21201

Information submitted through this website is secure.

Questions or problems with your membership submittal? Contact IEIIS@aol.com

Membership Subscription

Name(Required)

First Middle Last Prefered Name

Highest Degree(s)(Required)

Phone(Required)

Email(Required)

Exact mailing address is required for mailing of IEIIS membership card.

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 (below).

Institution(Required)

Department(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership

Membership subscriptions are for two calendar years, expiring December 31 of the second year. For memberships received after October 1: Membership begins as of payment date; however, the following year will be considered year one. Example: Payment made October 30, 2023: membership expires 12/31/2025.

Is this a new membership?(Required)

Yes

If you are a Student member, provide name of Supervisor or Professor:

Is this is a status change (eg, from Student membership to Active membership)(Required)

Yes

Membership Choice(Required)

Would you like to be considered for an elected or appointed office in the IEIIS?(Required)

Yes

Are you interested in receiving information about products or services of possible interest to those in the endotoxin and innate immunity fields?(Required)

Yes

Free Student Memberships

Active Membership includes 2 free Student Memberships. You are encouraged to take advantage of this opportunity. Provide student information below.

Student #1

Student #1 Name

First Last

Student #1 Degree

Student #1 Full Mailing Address

Street Address Address Line 2 City State ZIP Code

Member Card to be Mailed

Student #1 Phone

Student #1 Email

Student #2

Student #2 Name

First Last

Student #2 Degree

Student #2 Full Mailing Address

Street Address Address Line 2 City State ZIP Code

Student #2 Phone

Student #2 Email

CAPTCHA