2010 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 renewing and your contact info is the same as last year, check this box and just fill in the member Name & Email.

Please read this! If the credit card holder is not the member, enter the credit card holder's name & email in the spaces below the member. Also, American Express Corporate Cards are not accepted by PayPal. Use a difference card, or pay with check or postal order (see above).

Section I - Contact Information for Member

Member Name

Member Email
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
 

Section II - Membership Options

Type of membership:

I am interested in joining the following Special Interest Groups or Committees: [Read all about it!]

Special Interest Groups
Canadian SIG
Multi-Cultural SIG
RADAR Network SIG
South East Asian SIG

Committees
Advocacy
Development
Governance
Information Technology
International Networking
Membership & Outreach

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

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