Member Application

Enter your information and then click the Submit button. Your name, institution, and email address will be made available to other SMR members on our “Search Membership” page.

Fields marked with * are required.

Personal Information
*First Name
Middle Name
*Last Name
* Password for SMR
* Confirm Password
Professional and Academic Information
*Institution/Company
Department/Division
Position/Title
Degree(s)
Please indicate your main field of interest Biology
Genetics and Epidemiology
Immunology
Clinical Investigations
Other

If "Other," please describe

Contact Information
*Address 1
Address 2
*City
State
(United States only)
State/Province
(Not United States)
*Zip Code/Postal Code If no zip code or postal code, please enter 00000.
*Country
*Phone
*Email
*Confirm Email
Membership Information
*Member Type 1 Year Full Membership ($125)
2 Years Full Membership ($225)
3 Years Full Membership ($325)
Student Membership ($20/year)
All Student applicants will be contacted for proof of student status.
*Would you like to make a tax–deductible donation? No $25 $50 $100
*Please select a payment type

If you elect to pay by check, money order, or by phone, your membership will not be activated until your payment is received and processed.

Credit Card via PayPal website (VISA, Master Card, AmEx, or PayPal account)
Credit Card by phone (call 505.272.6513), and we will process your credit card over the phone.
Check, Money Order, or Bank Transfer
Please send payment to:
Society for Melanoma Research
305 Hermosa Drive SE
Albuquerque, NM 87108-2613