Membership Application

The Society for Ultrastructural Pathology is a nonprofit organization committed to promoting the art and science of diagnostic electron microscopy. Its primary function is to provide increased opportunities for intellectual and social interchange between active practitioners of this craft. The central focus of the Society is on electron microscopy, but considered within its purview as well are other special technologies that may come to impact upon or interplay with the use of this tool in diagnostic applications. It is through the membership of individuals like you that are committed to Electron Microscopy, that the Society has gained its present status of leadership in the field.

The Society for Ultrastructural Pathology currently sponsors an annual Companion Meeting in conjunction with the U.S.-Canadian International Academy of Pathology and a weeklong meeting (Ultrapath) every two years. Ultrapath meetings have traditionally been excellent avenues for dissemination of current information in diagnostic electron microscopy. Additional membership benefits include access to the Society website ( http://sup.ultrakohl.com/ and http://khewanl.home.mindspring.com/), online conference site (http://sup.ultrakohl.com:8080/~3) and a discount subscription to Ultrastructural Pathology ( Taylor and Francis Group).

Please type or print the following information:

Please check one:

[ ] Technologist [ ] Ph.D. Electron Microscopist [ ] Research Associate [ ] Pathologist/Resident

Membership Dues: $30.00 (US dollars) for PhDs, research associates and pathologists; $20.00 for technologists and pathologists-in-training.
Note: Membership will not be in effect until after the membership fee is received.

Credit Card payments are accepted.

Mail the completed form to:

John Shelburne, M.D., Ph.D.
Department of Pathology, Box 3712
Duke University Medical Center
Durham, NC 27710 – 3712
Phone: (919) 286-6907
Fax: (919) 416-5950
Voice mail (919) 286-6968

CREDIT CARD PAYMENTS
PLEASE NOTE !!

If you prefer to pay your dues by Credit Card, you may do so. We now accept VISA, MASTERCARD, and DISCOVER cards. We do not accept any other credit cards.

Please fill out the form below completely and either mail it to me at this address:

John D. Shelburne, MD, PhD
Department of Pathology
Duke University Medical Center
Box 3712
Durham, NC 27710-3712 USA

or Fax it to me at (919) 416-5950. (fax machine is located in a secured/private location)

CREDIT CARD: (Circle one) MASTERCARD VISA DISCOVER

NAME OF CARDHOLDER – EXACTLY AS PRINTED ON CREDIT CARD (Print):

_______________________________________________________________

CARD NUMBER: ___________________________________________________

AMOUNT (US Dollars): ______________________

EXPIRATION DATE ON CREDIT CARD: __________________________

SIGNATURE OF CARDHOLDER: ______________________________________

Billing address for this card (if different from the address on this letter):

___________________________________________________________________

___________________________________________________________________

Thank you! Please call me at (919) 286-6907 if you have any questions.

John D. Shelburne, MD, PhD
Secretary/Treasurer
Society for Ultrastructural Pathology