Membership: applications, renewals

Name *

First

Last

Email *

Email

Confirm Email

Phone (preferred)

Are you a new or renewing member? *

New member
Renewing member

Expertise/Interest/Profession (please tick all that apply) *

Please specify: *

Sector/Main area of practice (please tick all that apply) *

Renewing members: Have your other details changed (ie organisation, address, biographical details)?

Yes
No

Organisation you are affiliated with (if any)

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Biographical details. Please provide a brief summary of your particular interests, skills and experience in improving the use of medicines that ISIUM can share with other members.

Select your membership type (US$) *

Before making a selection, please check your country's classification (low-income countries are displayed when this option is chosen, see country classifications above for a full list). The term of membership is 12 months from the date you first pay your membership fee or, if you select the 3-year option, 36 months from the date you pay your membership fee.

Low-income countries

Afghanistan; Benin; Burkina Faso; Burundi; Central African Republic; Chad; Congo, Dem. Rep.; Eritrea; Ethiopia; Gambia, The; Guinea; Guinea-Bissau; Haiti; Korea, Dem. People's Rep.; Liberia; Madagascar; Malawi; Mali; Mozambique; Nepal; Niger; Rwanda; Sierra Leone; Somalia; South Sudan; Syrian Arab Republic; Tajikistan; Tanzania; Togo; Uganda; Yemen, Rep.

New members only

Company guarantee payment (US$8.00)

In addition to the membership fee, each new member is required to pay a single one-off payment of US$8.00 for the company guarantee. (ISIUM is set up in Australia as a not-for-profit company ‘limited by guarantee’. ‘Limited by guarantee’ refers to the maximum liability of each member if the company is wound up while the member is a member, or within 12 months after they stop being a member. Each member’s guarantee is limited to eight dollars (US$8.00) and this is required to be paid in advance. This one-off payment will be refunded to you if you cease to become a member.)

After completing this form, you’ll be taken to a secure payment page to complete your membership.

Apply to become a member!

Payments

Application/renewal

Low-income countries