AMERICAN SOCIETY FOR MICROBIOLOGY MARYLAND BRANCH
MEMBERSHIP APPLICATION
January 1, 2011 – December 31, 2011
- PERSONAL DATA- PLEASE COMPLETE ALL INFORMATION
(PLEASE PRINT)
NAME:______
Last nameFirst nameMiddle initial
Email Address:______
MAILING ADDRESS;__ business__home
PHONE & FAX NUMBERS –PLEASE PROVIDE both BUSINESS AND HOME TELEPHONE NUMBERS
PHONE: Business______Home______
FAX: Business______Home______
CURRENT POSITION/TITLE:
EMPLOYER______
HIGHEST DEGREE______IN THE FIELD OF______
DO YOU SUPERVISE GRADUATE STUDENTS?__YES__NO
II.BRANCH MEMBERSHIP – CHECK ONE CATEGORY AND STATUS
__ACTIVE:New______Renewal______
__STUDENTA:New______Renewal______
__EMERITUSB:New______Renewal______
- Indicate your degree program and institution______
______
- Payment of dues is voluntary if retired from remunerative professional work.
III NATIONAL ASM MEMBERSHIP – PLEASE COMPLETE ALL INFORMATION
NATIONAL ASM MEMBER? __YES__NO
IF YES, MEMBERSHIP NUMBER:______
IV. MEMBERSHIP INTERESTS
WOULD YOU BE WILLING TO SERVE ON ONE OR MORE COMMITTEES OF THE MARYLAND BRANCH? IF YES, PLEASE CHECK ALL THAT INTEREST YOU:
__Career Guidance__Long Range Planning__Membership__Auditing
__Nominating__Science Fair Judging__Awards
V. PAYMENT INSTRUCTIONS
MAKE CHECK PAYABLE TO: TREASURER, MARYLAND BRANCH ASM
ACTIVE MEMBERS DUES: $15.00
STUDENT MEMBERS DUES: $5.00
IV. MAIL APPLICATION & CHECK TO:
Paulette Hammond
Secretary, MD Branch ASM
401 Westshire Road
Baltimore, MD 21229
VII. BRANCH SURVEY FOR NATIONAL ASM?
WHICH AREA BEST DESCRIBES YOUR JOB (Check only one)
__Clinical (hospitals, labs)__Applied (industrial, environmental)__Other
__Basic Research__Education__Not sure which category fits
VII. SIGNATURE ______DATE______
PLEASE TAKE A FEW MOMENTS TO FILL OUT THE APPLICATION COMPLETELY, AS WELL AS READ OVER THE DIFFERENT WAYS YOU CAN BECOME INVOLVED IN OUR BRANCH.
Committee and Duties
Career Guidance: Composed of a chairperson and three members. The committee will be responsible for maintaining direct liaison with local educational institutions, for planning activities designed to advise students of career opportunities in the field of Microbiology, and for coordinating the efforts of individual members in implementing these activities.
Long Range Planning: Composed of the President-Elect, Vice-President and at least two active or emeritus members of theBranch. This committee shall propose long term activities and endeavors to be conducted by the Branch and assist the Executive Committee in implementing these goals.
Membership: Consists of the Secretary and Treasurer as chairpersons and one or more members.
Auditing: Consists of two active members and reports to the membership yearly.
Nominating: Consists of a chairperson and two addition members excluding current officers. The committee’s duties are to select candidates for election and submit names prior to the last regular meeting of the fiscal year.
Science Fair: Consists of a chairperson and any active members. Members of this committee engage in judging local science fairs.
Award: Consists of a chairperson and two members. The duties of this committee are to select recipients for the annual awards.