ASN Electronic Application Form
Online Membership Application Form

Use this form to apply for membersip to ASN electronically. Information on membership in ASN can be found here.

Membership dues are currently:

Do not send membership dues now. You will be sent an e-mail upon acceptance of membership with a link to our Secure Online Store.

Membership Category:
Membership category requested. 
    Choose from these categories and write in box:  Ordinary, Corresponding, Emeritus

Personal Information:

Name (Last, First Middle):    
Degree(s): 
Academic Rank:
Current Position:    
Department: 
Institution: 
Address: 
City,State: 
Zip:  
Country:  
Phone:  
Fax:  
E-mail:
(Complete email address, e.g. "jdoe@foo.edu"!) 

E-mail:
(to verify accuracy) :
Gender (M/F)
Minority?
(Yes/No) :

I am a citizen of, or currently reside in 
Applicants for Ordinary membership must reside on the American Continent.

This application must be sponsored by one Ordinary Member of the Society. Name of sponsor:

In submitting this form I state that I share the aims of the American Society for Neurochemistry and Understand that the Society reserves the rights to assign me the category of membership that appears most appropriate for my qualifications.

Please email your current NIH Biosketch or a curriculum vitae as an attachment to Vlad Parpura.

 

For Questions Regarding this Membership Application Form
Please Contact :

Vladimir Parpura, M.D., Ph.D.

Department of Neurobiology,

1719 6th Avenue South, CIRC 429

University of Alabama

Birmingham, AL  35294-0021

Phone: (205) 996-7369
Fax: (205) 975-6320

Email: vlad@uab.edu


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