About President’s Welcome Mission Statement Board of Directors Past Presidents Bylaws Contact Patients What Is Male Infertility? Causes of Male Infertility Diagnosing Male Infertility Treatment for Male Infertility Surgical Treatment for Male Infertility Medical and Other Treatments Patient Support Resources Patient Education Forum Fertility & Cancer Professionals Male Infertility Guidelines Participating Organizations Research Traveling Fellowship Programs The SSMR & SMSNA Traveling Fellowship Program Belker Traveling Fellowship Fellowship Opportunities Onco Fertility for Physicians Job Board Membership Member Benefits Categories of Membership Apply for Membership Member Portal Member Dues Member Directory Meetings & Webinars Upcoming Meetings Past Meeting Materials Past Webinars Awards Distinguished Reproductive Urology Award Arnold Belker Traveling Fellows SSMR & SMSNA Traveling Fellows Industry Partners News & Research Recent News & Events Newsletters Latest Research Research Spotlight Find a Doctor Directory Opt-In Instructions Fertility & Cancer Information for Physicians Information for Patients Member Benefits Categories of Membership Apply for Membership Member Portal Membership Application Membership Category Active Member ($195.00)Resident/Fellow/Postdoctoral Student Member ($0.00)Graduating Fellow Member ($0.00) 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 fertilityAt least 3 months of basic or clinical training in male reproductive surgery or medicineDemonstrated 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 --Select Prefix-- Assoc. Prof. Col. Commander Dr. Drs. Hon. Judge LT/COL LTC Maj. Miss Mr. Mrg. Mrs. Ms. Prof. Prof. Dr. Rev. Prefix Professional Title Designation/Degrees First Name Middle Name Last Name --Select Suffix-- II III IV Jr. Sr. Suffix Birth Date (MM/DD/YYYY) Gender Email Contact Phone Postgraduate Training Information Internship Internship Institution Internship Location Internship Graduation Year Residency Residency Institution Residency Location Residency Graduation Year Fellowship Fellowship Institution Fellowship Location Fellowship Graduation Year Board Certification Certification Board Name Board Certification Year Applicant Addresses --Preferred Mailing Address-- Office Home Preferred Mailing Address 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 Home Address Home Address Line 1 Home Address Line 2 Home Address Line 3 Home City Home State/Province Home ZIP/Postal Code Home Country Home Phone TOTAL AMOUNT DUE: Payment Information (must be made in U.S. dollars) CheckCredit Card -- Select Card -- Visa MasterCard American Express 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 Signature Email Address Telephone Number Signature Date I Agree that I represent and acknowledge that: I have read, understood, and consented to electronic delivery of the data collected and payment entered above. I have granted authorization to SSMR in association with WJ Weiser & Associates, Inc. to charge the amount indicated on the credit card provided. I am the authorized user of the credit card listed above and that the associated information entered (account holder name, account number, billing address, etc.) is accurate. I intend the act of selecting “I Agree” to be my legal signature to this agreement. Enter Security Code: 117111