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ISACCD Home > CHD Community > Join ISACHD > Membership Application Questionnaire
Membership Questionnaire

Join the International Society for Adult Congenital Heart Disease in its mission to promote excellence in the care of adults with congenital heart disease. By supporting ISACHD as a member or donor, you are joining the only international organization dedicated to the advancement of knowledge and training in medical disciplines pertinent to congenital heart disease in adults.

Membership benefits include:

The Society meets formally twice a year at the Annual Scientific Sessions of the American Heart Association and the American College of Cardiology.

Category Annual Dues
Physicians/Surgeons $95.00
Nurses/PAs/Other professionals $60.00
Fellows in Training $35.00

 

This questionnaire must be completed in order to become a member of the ISACHD. The data is only for statistical purposes and does NOT influence the applicant's eligibility for membership. All fields are required, except for "Sponsor".

Applicant:

Name:

Membership Type:

Physician/Surgeon
Professional (Nurses, Physician Assistants and other healthcare providers)
In-Training

I would like to also join the International ACHD Nursing Network (IACHDNN) within ISACHD. (There is no additional fee.)

Discipline:

Advanced Practice Nurse
Cardiologist
Cardiovascular Surgeon
Certified Nursing Assistant
Pediatric Cardiologist
Physician Assistant
Registered Nurse

Other:

Education:

Institution:
City: State: Zip:
Date Graduated: Degree:

Medical and/or other professional society memberships:

(If none, enter "none".)

Hospital affiliation:

Type of institution:
Private
Veterans Administration
University
City or County

Other:
Size of institution:

Patient Population:

Experience with adults with congenital heart disease:


Sponsor (if applicable)

Name:

 

You will be redirected to our secure membership sign-up page. Thank you.



International Society for Adult Congenital Heart Disease
1500 Sunday Drive, Suite 102
Raleigh, NC 27607
United States of America
Phone: 919-861-5578
Fax: 919-787-4916
© 2002-2010 International Society for Adult Congenital Heart Disease. All Rights Reserved.