Checkout - ISAM

You have selected the ISAM Medical Practitioner - physician or specialist membership level.

CRITERIA: Basic medical degree and/or specialist registration in the field of addiction.

The price for membership is $150.00 every 12 Months.

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

Title

First Name (capital only on first letter please)

Last Name (capital only on first letter please)

Gender

Contact Email (may be different from user email)

Street Address

City

Postal Code/Zip Code

Province/State

Country

Phone (with country code)

Fax (with country code)

I agree to share the information below on the ISAM member directory (only visible to members)

Area of Speciality

Primary Type of Practice

Short Biography

Please tell us how you heard about ISAM?

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Card Number

Expiration Date /

Security Code (CVC)

Discount Code

Processing...