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STREET CITY STATE ZIP
INSTITUTION STREET CITY STATE ZIP
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IF THIS IS YOUR FIRST APPLICATION COMPLETE THE FOLLOWING:
INSTITUTION DEGREE/CERTIFICATE
____________NEW APPLICATION *FULL:_____________$40
____________RENEWAL * ASSOCIATE:_____________$40
STUDENT:_______________$20 FOR 14 MONTHS (WHILE FULL TIME NUCLEAR MEDICINE STUDENT)
CHANGE OF ADDRESS/NAME__________________________________________________________________________________
PLEASE REMIT TO: SCSNM
Eileen Harp
561 Penn Rd.
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SIGNATURE DATE
MEMBERSHIP YEAR RUNS FROM
NOVEMBER 1, 2007 TO OCTOBER 31 2008
*FULL MEMBER: FULL MEMBERS MUST BE ACTIVELY EMPLOYED IN THE PRACTICE OF NUCLEAR MEDICINE. MEMBERS IN THIS CATEGORY WILL PAY DUES, HAVE VOTING PRIVILEGES, AND MAY HOLD EXECUTIVE OFFICE OR SERVE ON THE COUNCIL OF THE SCSNM
*ASSOCIATE MEMBER: ASSOCIATE MEMBERSHIP IS RESERVED FOR THOSE INDIVIDUALS WHO ARE INTERESTED IN THE NUCLEAR MEDICINE PROFESSION, BUT WHO DO NOT MEET THE QUALIFICATIONS FOR FULL MEMBERSHIP. MEMBERS IN THIS CATEGORY WILL PAY DUES, HAVE NO VOTING PRIVILEGES, MAY NOT HOLD EXECUTIVE OFFICE OR SERVE ON THE COUNCIL OF THE SCSNM.
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