ISMR New Member Application

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Member Overview / Summary
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Contact Info Mailing Address needs to be updated:
Contact Name:
Membership ID:
Contact Email Address:
Membership Classification:
Current Amount Due: $        
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Member Classification applying for *

Login Information
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Contact Information
First Name/Given Name/Forename: *
Last/Surname/Family Name: *
Country: *
Address 1: *
Address 2:
City: *
Zip/Postal Code:
Telephone Number (include country code):
Email Address: *
Uncheck the following box if you do not want to be listed on the ISMR Find a Member tab*  
Affiliation Information
University / Institution / Affiliation / Private Practice:
Position / Title:
Personal / Private Practice Website URL:
Education & Credentials Information
Undergraduate School Attended:
Undergraduate Degree Completed on:
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Graduate School Attended:
Graduate Degree Completed on:
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Are you currently enrolled in a full time recognized Prosthodontic training program?

Member Photos

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Member Registration Payments
Membership Dues for 2024

ISMR Donation Options:
Enter an optional donation amount
for one of the 2 funds
ISMR Donation Amount (Link to >> ISMR Donations Details coming soon)

Outreach Fellowship Donation Amount (Link to >> Outreach Fellowship Program Details coming soon)

Credit Card Information
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(Administrative Use Only!)
Payment History
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Donation History
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Make a Donation
Credit Card Information
Donation Option *
Donation Amount * $
Card Type:  
Card Number *
Card ID/CCV * (3 or 4 digit number on back of card)
Card Expires *
Name on Card * First: Last:

(Administrative Use Only!)
Member Classification Change Request.
Fill out your comments below about why you wish to change. Click [Request Change] next to the Classification below that you wish to change to. The Membership Committee will review your request for consideration.
Constituent (Annual Dues: $245, Processing Fee: $75 , Includes Journal: No)
Constituent Members of the ISMR shall be those individuals who have completed a professional qualification in medicine, dentistry, rehabilitation medicine or allied healthcare professions with relationship to maxillofacial rehabilitation. Scientists with a demonstrated interest related to maxillofacial rehabilitation will also be eligible to be considered for membership.
Life-Member (Annual Dues: $0 , Includes Journal: No)
Life Members of the ISMR shall be those Constituent Members who apply for Life Membership, or are proposed by the Board of Councilors, and who have:
- Held memberships in the ISMR for at least ten consecutive years immediately prior to applying or being proposed and have attained the age of 65.
- Because of illness, retired from active participation in work related to maxillofacial prosthetics.

Life Members may not vote in ISMR business or elections and may not hold elective office.