Application to Join the ISMRM African Chapter

Application
to Join the ISMRM African Chapter

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

A copy of your responses will be emailed to the address you provided.

Institution*

City & Country*

City Country

Primary Discipline*

Clinician

Basic Scientist

Radiographer or technician

Are you a member of the ISMRM/ISMRT?*

Yes, ISMRM

Yes, ISMRT

Your ISMRM or ISMRT Member ID Number*

Membership Requirements

Full Member

You must be either a member of ISMRM or ISMRT to qualify. Eligible for members rates. Students of full members are eligible for stipends.

Student Member

Must be registered for a degree. Non-voting.

Ordinary Member

Non-voting. Not eligible for members rates and students not eligible for stipends. African Chapter of the ISMRM members ONLY.

Choose an African Chapter membership type*

Full Member (ISMRM/ISMRT full members only)

Student Member

Ordinary Member

Degree type*

i.e., B.Sc./B.A. Cand., M.Sc. Cand., Ph.D. Cand., M.D. Cand.

Your Supervisor's Name and Email*

Please provide the name and email of your supervisor. They will be asked to confirm your status and expected date of completion of your Ph.D.

Supervisor's Full Name

Supervisor's Email

Expected date of completion of studies*

Note: Six months after this date, you will be removed from the database and you will need to re-register again.