International Lyme And Associated Diseases Society
Leaders in Lyme Disease Education and Training
 
 
Membership Levels
 Voting Regular Member $300.00
 Voting Retired Member (Discounted) $100.00
 Non-Voting Affiliate Member $200.00
 Non-Voting Retired Member $200.00
 Non-Voting Sustaining Member $200.00
 Non-Voting Student Member $100.00
 Monthly Installment $25.00
 
Membership Information
    
Primary Address is Business:
Home Address 1:
Home Address 2:
Home City:
Home State:
Home Zip Code:
Home Phone:
Home Fax:
Personal E-mail:*
Mobile Phone:
Second Business Phone 2:
WebSite:
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Membership In ILADS does not signify certification or confirmation of a member's training or experience in diagnosing or treating patients with Lyme and associated diseases. Healthcare providers may not utilize ILADS membership in any communication to patients or potential patients to support the member's competence in treating Lyme and associated disease.

I certify that I have read this statement and agree to abide by its content.
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CERTIFICATIONS
The Certification 1 fields are required. If not applicaple to you, type in 'Not Applicable.'

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SCHOOLS
The School fields 1 and 2 are required. If not applicaple to you, type in 'Not Applicable.'

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RESIDENCIES / PROFESSIONAL TRAINING
The Residency 1 fields are required. If not applicaple to you, type in 'Not Applicable.'

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MEDICAL / SCIENTIFIC / PROFESSIONAL ORGANIZATIONS
The Professional Organization 1 fields are required. If not applicaple to you, type in 'Not Applicable.'

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COURSES / TRAINING RELATED TO LYME DISEASES
Please list Lyme disease training, conferences attended and courses along with dates. If none, please type 'None' or 'Not Applicable.'

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SPONSOR INFORMATION
If you do not have the required sponsor, please contact membership@ilads.org for assistance. In order to complete this registration process, you will have to fill in these fields. In all fields that you do not have information for, type 'Not Applicable.'

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APPLICANT INFORMATION
Has your license to practice medicine ever been revoked, suspended, or placed on probation for any reason? If so, explain.
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Please tell us more about yourself and why you would like to become an ILADS Member.
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Please type in your name. This will act as an electronic signature.
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SEND TO A COLLEAGUE
Do you know anyone who would like to receive information about ILADS? If so, please write his or her name, address, and email address on the lines provided below:
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* required field
Membership Categories
 MEM  
Credit Card Information
 
Please make sure the address below matches the address where your credit card statements are mailed. The transaction may be rejected if the address does not match.
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