Membership Registrant Information Name Address Address City State * Non-US State / Province Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Country * Australia Austria Belgium Brazil Canada Switzerland China Germany Spain United Kingdom France Italy Netherlands Poland Portugal Russia United States Contact Information Home Phone Work Phone Fax Number Email Membership Status Are you a new member, or a returning member? If you are a new member, please fill out the appropriate membership form below and submit it to the National Office. There is an additional $25 application fee for new members, which is waived for Students. New Member Application - Student New Member Application - Non-Student Returning New Member Fee Quantity Total Annual Dues $155.00 Fellow or Senior Member Fee Quantity Total Annual Dues $180.00 Student Fee Quantity Total Annual Dues $25.00 Total Note: Membership runs on the calendar year. If you pay dues mid-year, you will still be invoiced in January for the next calendar year. You will receive all back issues of the journal Perfusion for the current year.