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Proof of Status

If you are applying for IADMS membership or Annual Meeting registration at a reduced fee (as a student, healthcare trainee, or senior), please complete this form and provide the necessary information.

You must attach a file which provides proof of your status.

Students or healthcare trainees must attach a file with written proof of your status. This must be an official document from the school or institution where you are studying or training.

Seniors must attach a file with official proof of your date of birth.


First Name *
Last Name *
Address
City
Country
State
Postal Code
Phone *
Email Address *
Attach File:
Comments *
Validation Code: Answer this simple math problem to validate your submission:

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