CSM Membership Nomination Form
THIS IS NOT AN INTERACTIVE FORM! Please print this form off and send it, along with the membership fee, to the address listed at the bottom of this page.


Name:                                                                                                                                                                                                                                   


Mailing Address:                                                                                                                                                                                                             


                                                                                                                                                                                                                                                  


 


Telephone: (               )                                                                                  FAX: (                )                                                                                  


If available, e-mail:                                                                                                URL:                                                                                              


 


Information about your position, degrees, and interest in microscopy or related fields:


                                                                                                                                                                                                                                                


                                                                                                                                                                                                                                                


                                                                                                                                                                                                                                                


 


Please check areas in which you have experience and willing to share your knowledge with other members of the CSM.  The areas indicated will be listed with your name in the membership directory unless you state it otherwise (see below).

       Transmission EM (T)

       Confocal Light Microscopy (C)

       Image Analysis & Processing (IA)

       3D Reconstruction (3D)

       Scanning EM (S)

       Video Microscopy (V)

       Morphometry (M)

       Live Cell Monitoring (LC)

       Immunocytochemistry (IC)

       Fluorescence LM (F)

       Near Field (NF)

       FRAP/FRET (and other forms of resonance transfer) (FR)

       Cryosectioning (C)

       In situ hybridization (IS)

        Atomic Force Microscopy (AF)

       Materials Sciences (MS)

       Freeze Substitution (FS)

       Optical Diffraction (OD)

       Scanning Tunneling Microscopy (ST)

       Forensic Science (FO)

       Freeze Fracture (FF)

       Electron Diffraction (ED)

       Elemental Analysis (EA)

       Wide Field Light (WF)

       Autoradiography (A)

       Histology/Histopathology (HH)

       Desktop/Electronic Publishing (EP)

Other (List)                                                         

 
Please circle one of the following!
 
NO    - Do not include any of my information in a directory.
YES   - Include all of my information, including interests, in a member directory.
YES BUT ONE     - Include only my name and telephone number.
YES BUT TWO    - Include only my name, telephone number, and email address.
YES BUT THREE  - Include only my name and email address.
 

Membership Dues:

$20                   

$10                   

$75                   

Per Year, up to 3 years

(Regular)

(Student)

(Corporate)

Please make check payable to CSM and return with application to:   Christine Brantner, CSM Treasurer, NIH 9000 Rockville Pike, Building 49/room 3A60, Bethesda MD 20892-4477

Date Presented to Council:                                                 Action:                               

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