Medical Image Perception Society Membership Form - Complete then Print using the button below

Name:
Title:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Phone:
Fax:
eMail:
Interest in Perception	Models For PerceptionROC AnalysisImage Reader PerformancePsychophysicsVisual SearchOther
Committee:	Willing to serve on the ExecutiveMembershipNominatingRulesResearch & EducationCommunications commitee.
Membership Type: Annual Dues	$50.00 - Full Membership $25.00 - In-Training Membership* *Member-in-Training: Any person who is currently engaged in an accredited program of education or of post-graduate training, including residency and fellowship. Please provide proof of student status either in the form of a copy of the dated student ID or a letter from the advisor.
Scholar Support Fund Donation:	$ Contributions to the Scholar Support Fund are tax deductible contributions to a non-profit organization under the United States Internal Revenue Service Code.
Total:	$ Please indicate the total amount (membership dues + fund contribution) that is being mailed.

Elizabeth Krupinski, PhD
Department of Radiology & Imaging Sciences
Emory University

1364 Clifton Rd NE

Atlanta, GA 30322

MIPS is a tax exempt organization under section 501(a) of the United States Internal Revenue Service Code as an organization described in section 501(c) and is treated as a publicly supported organization.
Dues payments to MIPS are not considered tax deductions, but contributions to the Scholar Support Fund are tax deductible contributions to a non-profit organization under the United States Internal Revenue Service Code.