2209 Dickens Road • Richmond VA 23230-2005 • Phone: 804-565-6360 • Fax: 804-282-0900

Membership Application

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*MEMBERSHIP CATEGORY:
 
*The tiered membership categories are based on the World Bank of Economies. Please refer to the SNACC website to determine which tier your country falls: https://www.snacc.org/membership/world-bank-membership-tiers
*While membership is not prorated you will be given a January renewal date if you apply three months before or after January 1st or a July renewal date if you apply three months before or after July 1st.
Active: Fellow/Resident/Student/Allied personnel:
(Includes online JNA) (Includes online JNA)
Category - A: $295 Category - A: $40
Category - B: $75 Category - B: $30
Category - C: $55 Category - C: $25
 
Add Printed Journal: None JNA Subscription $170 JNA Subscription - International $180

Resident: Membership dues and application must be accompanied by a letter from your residency program director as proof of status.
*First Name:
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*Last Name:
*Degree:
*Designation:
*Birthdate: Day: Month: Year:
*Institution:
 

Mailing Address

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*Home Phone Number:
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*E-Mail Address:
 

Billing Address

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*Residency/Fellowship Ends: / (MM / YYYY)
*Neuroanesthesia or Research Interest Areas
 
SPECIAL INTEREST GROUPS

If you have an interest in joining one or more SIGs, check below:

Sig1: Patient Safety and Quality Improvement Group
Sig2: Pediatric Neuroanesthesia Group
Sig3: Wellness and Healing Group
Sig4: Patient Outcome Research Group

 
AUTO RENEW (ACTIVE MEMBERSHIP ONLY)

Auto Renew

If you select "Auto Renew", your membership will automatically renew for successive one year periods until cancellation. Upon renewal, you authorize SNACC to charge the then-current membership fee amount to the payment method provided by you, for as long as you choose to remain a member. You can cancel your membership at any time by contacting the Society.

 

Payment

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For VISA or MasterCard it is on the back of your card in the signature box. The 3-digit code is printed on the right-hand side of your 16-digit credit card number.
For American Express the code is the 4-digit number printed on the front of your card either on the right-hand side directly above the credit card number or the left-hand side directly above the credit card number.

This is a secure transaction system. However, additional documentation may be required.

By submission of this form I agree to the terms of payment.

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2209 Dickens Road, Richmond, VA 23230-2005 · Phone: 804-565-6360 · Fax: 804-282-0090 · snacc@snacc.org
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