ITMA
International Traffic Medicine Association
Devoted to reducing harm from traffic crasches

Application for membership.

Please, fill in textboxes, tick appropriate checkboxes, make necessary changes, and return the form to the treasurer by clicking the "Send data ..."  and then Pay-Pal-button "Donate" at the end of this form!

 
Last name :    First name:         Other initials    
Dicipline: 
Degree:
Title:
Telephone:     Fax:    


Position:
Organization:
Address for
corre-
spondence



City
Country
   Zip-code   State:  

ITMA dues were set at USD 85.00 to present as low barrier as we could to encourage participation by the widest possible range of occupations from all nations. However, everyone is encourraged to add a voluntary additional contribution to support the goals of the organization; members accustomed to substantially higher professional society dues are particularly encouraged to consider increasing their total ITMA dues closer to levels with which they are more familiar.

Membership dues: USD 85.00 / year

ITMA's goal is to embrace the entire world, which contains countries with widely varying economic conditions. Also, individual circumstances vary greatly. Accordingly, two special membership dues categories are available. Please check appropriate checkbox if you are eligible for one of these and wish to use it. (All members enjoy all member benefits.)
Total annual income from all sources between USD 10,000 and 20,000. Dues is  USD 45.00 / year.
Total annual income from all sources under USD 10,000. Dues is USD 15.00  / year.


How to proceed .........

1. Send the above completed form to ITMA treasurer by clicking "Send data to ITMA treasurer" - button below.
2. Pay the annual dues (plus an extra contribution if you want) by using the "Pay Pal Donate"  button.  

          

If you don't have a Pay Pal account and not want to create one - use the "Continue" option at the linked Pay  Pal web site which is shown when you have clicked the Donate button.
It is also possible to send a check made out to ITMA. Send it to ITMA treasurer Sven G Hultman, Kapplandsv. 6, SE 16836 BROMMA, Sweden.
If so, please mark the checkbox here!

Thank you for joining ITMA!