Membership Application

Pays full dues and has voting privileges. Qualifications: Individuals interested in male reproductive health with:
(please check all that apply; must fulfill at least one)

Dues waived and may not vote. Additional Qualification: Letter of recommendation from program director required.

A Fellow that has recently graduated. Dues waived and may not vote.

At least 20% of clinical practice or research effort must be in the area of fertility
At least 3 months of basic or clinical training in male reproductive surgery or medicine
Demonstrated an interest in male reproduction by attending 3 SSMR meetings, or 2 SSMR meetings and a subject-oriented seminar dealing with infertility sponsored by the AUA (completed within a 5-year period)

Graduation Year:

Applicant Information

Postgraduate Training Information

Applicant Addresses

Office Address

Include me in the member directory of the website.
Include me in the provider directory of the website.

Company Name
Website URL
Office Address Line 1
Office Address Line 2
Office Address Line 3
Office City
Office State/Province
Office ZIP/Postal Code
Office Country
Office Phone

Payment Information (must be made in U.S. dollars)

CheckCredit Card

Card Type
Name As It Appears on Card
Credit Card Number
Expiration Date (MMYY)
Card Verification Number
Billing Information
Billing Street Address
Billing ZIP Code

If paying by check, make check payable to: Society for the Study of Male Reproduction

Mail payment to:
Society for the Study of Male Reproduction
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

PLEASE NOTE

Membership Category

Applicant Information

Postgraduate Training Information

Applicant Addresses

Office Address

Home Address

Payment Information (must be made in U.S. dollars)