AMIA Home PagePersonal Information
Name__________________________________________________________________________ Degree/Title__________________________________________________________________ Institution/Organization______________________________________________________ Address_______________________________________________________________________ City/State/Zip________________________________________________________________ Country_______________________________________________________________________ Business Phone________________________________________________________________ Fax___________________________________________________________________________ E-Mail Address(es)____________________________________________________________ Sponsor's Name (who encouraged you to join AMIA?)_Dean F. Sittig, Ph.D._______
___ Please do not include my name on mailing lists given to other organizations.
___ Please do not include my name in the AMIA Yearbook and Directory.
Membership Category
___ Regular Member - $235 includes physicians, nurses, dentists, biomedical engineers, educators, medical librarians, researchers, and other health care professionals who have a strong interest in medical informatics. Regular members receive JAMIA and newsletters at no additional fee. Discounts for AMIA Spring Congress and AMIA Annual Fall Symposium apply.
___ Institutional Member - $365 includes nonprofit organizations, nonprofit associations, nonprofit universities, nonprofit hospitals and libraries. All Regular member benefits apply for one individual designated as an AMIA contact person. Additional benefits include conference publications and promotional opportunites offering support and exposure.
___ Corporate Member -$2,500, $5,000, $10,000 includes for-profit corporations that are vendors to the medical informatics community, such as hardware and software vendors, and consulting firms. Please contact AMIA for the special Corporate membership packet.
___ Retired Member - $100 includes retirees at least 60 years of age who have been members of AMIA for the past two years or longer. The benefits of Regular membership apply.
___ Student Member - $30 includes persons currently enrolled full-time in a degree- granting program or in a academic program such as a medical residency or post-doctoral fellowship. A letter from the institution attesting to the student's status is required with membership application. Students are automatically included in the Student Working Group roster. Students may purchase journals. Discounts apply.
___ Associate Member - $30 for one year only. Individuals may join one working group. No Regular member benefits apply. No journals or newsletters, no AMIA Spring Congress or AMIA Annual Symposium discounts. At the end of the year, Associate members are expected to renew at Regular member rates and will then receive services.
Profile
Please indicate your occupation(s). Check all that apply.
___ Physician (MD) ___ Programmer (PR) ___ Dietician (DT) ___ Systems Analyst (AN) ___ Pharmacist (RX) ___ Computer Scientist (CS) ___ Physical Therapist (PT) ___ Business Administrator (BA) ___ Educator (ED) ___ Technologist (TX) ___ Engineer (EN) ___ Hospital Administrator (AD) ___ Nurse (RN) ___ Medical Librarian (ML) ___ Dentist (DS) ___ Health Information Professional (HI) ___ Undergraduate Student (US) ___ Vendor/Consultant (VC) ___ Fellow (FW) ___ Veterinary Medicine (VT) ___ Graduate Student (S) ___ Scientist/Researcher (SR) ___ Other (please specify): ______________________
Working Group Program
Working Groups
AMIA members who join WGs can vote, serve in leadership positions, and participate in the WG listserve. Regular, Retired, Institutional, and Corporate members may join two WGs at no added charge; each additional WG membership is $25. Associates may join one working group which is included in their $30 dues. Students are automatic members of the Student WG; they may join other WGs for $15 per WG.
___ Clinical Information Systems (42)
___ Clinical Trials (43)
___ Consumer Health Informatics (08)
___ Dental (04)
___ Education (01)
___ Ethical, Legal and Social Issues (39)
___ Family Practice/Primary Care (10)
___ Genomics (44)
___ Internet (03)
___ Medical Imaging Systems (22)
___ Nursing Informatics (02)
___ People and Organizational Issues (38)
___ Quality Improvement Informatics (45)
___ Student (11)
___ No Working Group membership desired
Special Interest Groups (SIG) Participation
Special Interest Groups have no distinct membership. AMIA members may participate in the listserve at no charge.
___ Anesthesiology/Critical Care and Emergency Medicine (37)
___ Natural Language Processing (14)
___ Prevention and Public Health (41)
___ Telehealth (40)
AMIA Publications
Regular, institutional, Corporate, and Retired members receive JAMIA, the Journal of the American Informatics Asssociation automatically. These members may wish to purchase subscriptions to Computers and Biomedical Research at the specially discounted subscription rate below. Student members may purchase JAMIA or these journals at special AMIA member prices:
___ JAMIA ($30 - Student discount only)*
___ Computers and Biomedical Research ($60)
* Nonmembers who wish to subscribe to JAMIA may call the publisher, Hanley & Belfus, at 215-546-7293 or 1-800-962-1892.
All members may purchase the following publications:
___ AMIA 1999 Annual Symposium Proceedings
___Print ($95 + $6 postage & handling = $101)
___CD-ROM ($75 + $2 postage & handling = $77)
___ AMIA 1998 Annual Symposium Proceedings
___Print ($75 + $6 postage & handling = $81)
___CD-ROM ($75 + $2 postage & handling = $77)
___ AMIA 1997 Annual Symposium Proceedings
___Print ($75 + $6 postage & handling = $81)
___CD-ROM ($55 + $2 postage & handling = $57)
___ AMIA 1996 Annual Symposium Proceedings
Print only ($75 + $6 postage & handling = $81)
IMIA Yearbook of Medical Informatics - selected years:
___ 1999 ($50 + $4 postage & handling = $54 each)
___ 1997 ($30 + $4 postage & handling = $34 each)
___ 1996 ($20 + $4 postage & handling = $24 each)
Postage and Handling
Amounts for postage and handling above are for U.S. only. For
Canada and Mexico, postage and handling is $4 per Spring Congress
abstract book and $8 for all other publications; for other
countries, $8 per Spring Congress abstract book, and $34 for all
other publications.
___ A History of Medical Informatics in the U.S.: 1950-1990
($40, plus shipping and handling: U.S., $4; Canada and Mexico, $8; overseas, $20)
Our Federal Tax ID number is 52-1615853.
Payment Method (U.S. Dollars)
$___________ AMIA Membership $___________ Foreign Postage for membership (ADD $15) $___________ Additional Working Groups (see above) $___________ Proceedings/Publications $ __________ TOTAL (U.S. Dollars only) I enclose my: ___ U.S. Check (all checks must me in U.S. currency and payable through a U.S. bank) ___ U.S. Money Order ___ VISA ___ MasterCard ___ American Express Card Number _____________________________________ Exp____/____ Signature ____________________________________________________
Membership: ___ New ___ Renewal
Mail (or fax, if using a credit card) this application to:
American Medical Informatics Association (AMIA)
4915 St. Elmo Avenue, Suite 401
Bethesda, MD 20814
Phone: 301-657-1291
Fax: 301-657-1296
E-Mail: mail@mail.amia.org
New members who submit applications between January 1 and September 30 will be current year members and will
expire on December 31 of the joined year. These new members will receive all publications that have
been mailed to members throughout the year. New members who submit applications after October 1, will be held
until January of the following year at which time they will become full members and receive publications and services.