Application for FIDS Membership and Dues- 2015
Name of Applicant: Date:
(Please fill in form boxes. Use the tab key to move to next form field.)
Degree (check all that apply): MD PhD DO PharmD FIDSA Other
Job Title:
Institution/Organization:
Contact Information for FIDS Correspondence:
Address 1:
Address 2:
City: State: FL Zip/Postal Code:
E-mail: Office Phone: Office Fax:
Contact Information for FIDS PUBLICLY VIEWED “Find and ID Physician” directory:
Same as above or with the following changes. Do not put my information online
Address 1:
Address 2:
City: State: FL Zip/Postal Code:
E-mail: Office Phone: Office Fax:
**PLEASE READ THE ATTACHED SHEET FOR DETAILS ON MEMBERSHIP CATEGORIES
I am applying for the following membership category (check one):
Member-in-training (Dues none) Include your training dates & required signature.
Date training began: . Date training will end:
Name of Hospital or School:
Program Director: Signature ______
Director’s e-mail, telephone number or fax:
New Member (Dues $100)
Include the required nominating signature, your curriculum vitae and your dues payment of $100 made payable to Florida Infectious Disease Society
Name of Nominating
FIDS Member Signature ______
(The nomination must be by someone who is currently a member of FIDS. You cannot nominate yourself. )
Associate Member (Dues $100)
Include your dues payment of $100 made payable to Florida Infectious Disease Society
Established Member (Dues $100 -annual assessment)
Include your dues payment of $100 made payable to Florida Infectious Disease Society
Organizational Member (Dues $150)
Mail this form and your payment to: Patricia Oviedo
FIDS Administrative Secretary
2047 Meeting Place
Orlando, FL 32814
Categories of FIDS Membership
Member-in-Training: Individuals are eligible to join FIDS as Members-in-training as soon as they enter a postdoctoral program in infectious diseases, clinical microbiology or a related field. Members-in-training do not have voting privileges.
Criteria: · Identification with infectious diseases
· Documented participation in an accredited postgraduate training program in infectious diseases
· Nomination by the program director of an accredited ID fellowship
To Apply: · Complete the FIDS Membership and Dues form
· Have your application signed by your training program director
· You are NOT assessed dues payment with your application
New Member: Individuals are eligible to become members immediately upon completion of postdoctoral or equivalent training in infectious diseases or a related field. Physicians without formal ID training are eligible if the majority of their professional activities are in infectious diseases or a related field, such as HIV/AIDS. Members have full voting privileges and may serve on FIDS committees and task forces. (*Note: applicants who, after review, are found not to be eligible for full Member status will be offered an Associate Member membership)
Criteria for Acceptance:
· Continuing identification with the field of infectious diseases
· Nomination by a current FIDS member
· Acceptance by the FIDS Executive Board
To Apply: · Complete the FIDS Membership and Dues form
· Have your application signed by an FIDS member
· Submit your curriculum vitae
· Include a dues payment with your application
Associate Member: Individuals who do not have specific postdoctoral or equivalent training in ID or a related field may apply for Associate Membership in order to take advantage of the educational opportunities provided in FIDS. These include Microbiologists, PhD’s in Pharmacology, Public Health Officials, Infection Control Nurses, PA’s, ARNP’s, and those in Industry or Epidemiology with Infectious Disease interests. Associate Members will have voting privileges and may attend the Annual Meeting as well as other FIDS conferences and activities at member rates.
Criteria for Acceptance:
· Interest in FIDS and infectious diseases or a related field
· Approval by the FIDS executive board
To Apply: · Complete the FIDS Membership and Dues form
· Submit your curriculum vitae
· Include a dues payment with your application
· Have your application signed by a FIDS member
Established Member
Criteria for Continuation of Membership:
· Currently a FIDS member in good standing
· Approval by the FIDS executive board
To Apply: · Complete the FIDS Membership and Dues form
· Include a dues payment with your application
Organizational Member: Individuals affiliated with Industry or Epidemiology
To Apply: · Complete the FIDS Membership and Dues Form
· Include a dues payment with your application