2017 SALIS Membership Application

Use this form to pay online with a credit card, using secure PayPal.
(to pay with a check or postal order, go here instead)

-- STEP 1:  FILL OUT APPLICATION FORM ONLINE.

This is a: New membership Renewing membership

If you are joining after the first quarter of the year, please contact SALIS Home as you are eligible for a pro-rated rate!

Please fill out the entire form.  We want to make sure we have all of your contact information.  Also be sure and review the descriptions for the Special Interest Groups (SIGs) and Committees, so you may sign up to be active in SALIS.

Important! If the credit card holder is not the member, enter the credit card holder's name & email in the spaces below the member. Note: American Express Corporate Cards are not accepted by PayPal. Use a different card, or pay with check or postal order using the print form (see above).

Section I - Contact Information for Member

Member Name

required!
Member Email required!
Name on Credit Card
(if different from member)
Credit card holder's email
Title
Organization
Address
City
State
Zip/Postal Code
Country
Phone
Fax
Web URL
 
NEW MEMBERS: Please tell us how you heard about SALIS -- SALIS member, colleague, website, other?

Section II - Membership Options

Type of membership:

NOTE: If you are joining mid-year or paying an amount different from one of the options, select "Other" and when you get to PayPal, enter the amount you agreed on with SALIS Home.)

Check if you are interested in the following Special Interest Groups or Committees: [Read all about it!]

Canadian SIG
Multi-Cultural SIG
RADAR Network SIG
South East Asian SIG

Advocacy Committee
Development Committee
Technology & Membership Committee
International Networking Committee


Full members only: check if you'd like to receive hard copies or electronic notications about:
NIAAA Publications
NIDA Publications
SAMHSA Publications