Membership

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Create your Membership

SIDM is a 501(c)3 tax-exempt organization.

SIDM EIN: 45-2670824

$75 - Student and Patient Membership

$200 - Individual Membership

Secure Payment

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First Name *

Last Name *

Gender

Title *

Please state your title (student, patient or your professional title)

Organization

Department

Email *

By providing your email address, you consent to receive emails regarding this transaction as well as updates on SIDM news and activities. You can unsubscribe at any time by following the instructions at the bottom of our emails.

Address Line 1

Address Line 2

City *

State/Province *

Zip/Postal Code

Country *

Secure Payment

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Include a submember in your membership registration

Include a submember

SUBMEMBER {{index+1}}: {{getSubMemberName(index)}}

Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

First Name *

Last Name *

Email *

Address Line 1

Address Line 2

City *

State/Province *

Zip/Postal Code

Country *

Add a submember

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$ Add a donation

Other Amount

{{donationOtherAmountLabel}} *

USD

Secure Payment

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{{orderSummary.membershipsTotal==0?'Free':formatAmount(orderSummary.membershipsTotal)}}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Donation

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Data Privacy & Consent

Secure Payment

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Card

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card Number *

Expiration (MM/YY) *

CVV *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip

Country

Data Privacy & Consent

Amount:

{{formatAmount(totalAmount)}} USD

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.