AMMI Canada Membership

Category

Notice

Details

Endorsement

Review

Complete

Application Categories
Active ($405.00 plus tax)
Member-in-Training ($50.00 plus tax)
Supporter ($62.00 plus tax)

For details on membership requirements and benefits, please refer to https://ammi.ca/en/membership/

Payment: An invoice and payment instructions will be provided following application approval.

Before continuing, please ensure that a current Active Member of AMMI Canada is willing to support and endorse your application for Active Membership or Supporter Category.

This application will ask you to specify the name and email address associated with the endorser’s AMMI Canada membership.

A transcript of your submitted application may be provided to the specified endorser for verification purposes.

If you do not know a current Active Member of AMMI Canada, please contact membership@ammi.ca for assistance.

Before continuing, please ensure that your Program Director and one current Active Member of AMMI Canada are willing to support and endorse your application for Member-in-Training. If your Program Director also holds an Active Membership in good standing with the society, only the Program Director’s endorsement is required.

The specified Program Director must also be able and willing to signify that you are currently enrolled in a training program.

Where applicable, this application will ask you to specify the name and email address associated with the endorser’s AMMI Canada membership.

A transcript of your submitted application may be provided to the specified endorsing parties for verification purposes.

If you do not know a current Active Member of AMMI Canada, please contact membership@ammi.ca for assistance.

Member Information

First name*

Last name*

Middle initial

Salutation:

Suffix

Language of Correspondence*:

Date of Birth (YYYY-MM-DD):

Gender*

Prefer not to say

Ethnicity*

Prefer not to say

Pronoun(s)*

Prefer not to say

Preferred Language of Communication*
(For Secretariat Membership Communication Only)

What is your main language at work*

Preferred address for all AMMI Canada Correspondence*

Home
Work

Work Address

Institution/Organization name*

Department*

Position Title*

Room #

Street Address*

City*

Province*

Postal Code*

Country*

Telephone*

Alternate/Mobile

Fax

Email address*

Alternate Email address

Assistant Name

Assistant Telephone

Assistant email
(used only by secretariat for scheduling purposes)

Home Address
(used only by secretariat)

Apt #

Street Address*

City*

Province*

Postal Code*

Country*

TelephoneTelephone*

Alternate/Mobile

Fax

Email address*

Alternate Email address

Which email address would you like to use to login to the members only website*

Home
Work

Would you like to be listed in the AMMI Canada Membership Directory*
(only accessible on the members only website)

Yes
No

Please include the following in my directory listing:
(greyed out options will be included for all listings)
First & Last Name
City
Province
Specialty
Institution
Phone Number
Email

Section/Specialty*
(Check all that apply and indicate percentage of time)

	Infectious Disease
	Medical Microbiology
	Internal Medicine
	Clinical Microbiology
	Paediatric Infectious Disease

Degree(s)*

Other:

Certification(s)

Royal College ID #:

CCM ID #:

ABBM ID #:

Other(s) (comma separated):

Training Institution(s):

Employment Affiliation(s)*
(Check all that apply and indicate percentage of time)

	University/Medical School
	Hospital/Clinic
	Community Laboratory
	Community Hospital
	Reference Laboratory
	Public Health
	Federal Government
	Provincial Government
	Other (ex. Pharmacy, Medical Laboratory Technology, etc.):

Primary Role(s)*
(Check all that apply and indicate percentage of time)

	Clinical Infectious Diseases
	Clinical/Medical Microbiology
	Basic Research
	Clinical Research
	Public Health
	Administration
	Infection Control
	Other (ex. Pharmacy, Medical Laboratory Technology, etc.):

Areas of Interest
(Check all that apply)

	Antimicrobial Stewardship and Resistance
	Bacteriology
	Basic Science
	Education
	HIV/AIDS
	Infection Prevention and Control
	Infections in Immunocompromised Hosts
	Laboratory Safety
	Molecular Microbiology
	Mycology
	Parasitology
	Pharmacology of Antimicrobials
	Public Health
	Quality Management
	Reference Microbiology
	Sexually Transmitted Infections (STIs)
	Transplant Infectious Diseases
	Tropical Disease/Travel Health
	Vaccines/Immunology
	Viral Hepatitis
	Virology
	Other

Additional Information

Receiving Information: AMMI Canada uses MailChimp as its distribution platform.

All AMMI Canada members are automatic subscribed to the membership information distribution list
per the AMMI Canada bylaws which includes dues renewals and information on the annual general meeting.

For all other information please select all that apply:
Select All
AMMI Canada: Updates and Information, Surveys, Job Postings, Committee and Working Groups Requests etc.
AMMI Canada: Guidelines, Position Papers etc.
AMMI Canada: Annual Conference
Other Organizations: Information, Surveys, Volunteer requests etc.

Are you willing to speak to the media on behalf of AMMI Canada*

Yes
No

Please select all the topics you are comfortable speaking to the media on:

	Antimicrobial Stewardship and Resistance
	Bacteriology
	Basic Science
	Education
	HIV/AIDS
	Infection Prevention and Control
	Infections in Immunocompromised Hosts
	Laboratory Safety
	Molecular Microbiology
	Mycology
	Parasitology
	Pharmacology of Antimicrobials
	Public Health
	Quality Management
	Reference Microbiology
	Sexually Transmitted Infections (STIs)
	Transplant Infectious Diseases
	Tropical Disease/Travel Health
	Vaccines/Immunology
	Viral Hepatitis
	Virology
	Other

Are you interested in volunteering on a working group, committee etc.?*

Yes
No

Please select all that apply:

Accreditation Committee
Annual Conference Scientific Planning Committee
Communications and Public Relations Committee
Continuing Professional Development Committee
Grants & Awards Committee
Inclusion Diversity Equity and Accountability (IDEA) Committee
OneHealth Working Group
Phage Working Group
Quality Standards and Evaluation Committee

Would you like to join the Clinical Research Network (CRN)*
Additional Membership Dues are $200,
this will be applied to your final invoice.

Yes
No

Why did you decide to join AMMI Canada?

Please specify a current Active Member of AMMI Canada who has agreed to support and endorse your application for membership.

Endorser*:

First Name:
Last Name:
Email Address:

The current Active Member's email address should be associated with their AMMI Canada Membership.

I understand that a transcript of my submitted application may be provided to the specified endorsing parties for verification purposes.

Please specify your Program Director who has agreed to support and endorse your application for membership. Your Program Director will also be asked to signify that you are currently enrolled in a training program.

Program Director*:

Salutation:
First Name:
Last Name:
University Affiliation:
Email Address:
Program Completion Year:
Program Completion Month:

Residents - Year of Study*


Medical Students - Year of Study*
Other:

Endorsement from a current Active Member*:

My Program Director is a current AMMI Canada Active Member.

OR

Below, please specify a current Active Member of AMMI Canada who has agreed to support and endorse your application for membership.

Endorser*:

First Name:
Last Name:
Email Address:

Review

Please review the information entered and click Submit Application to continue.

Application complete

Thank you. Your application is being submitted.

AMMI Canada has privacy protection policies in regards to confidential information submitted by membership candidates. These can be viewed here.

Member Information

Preferred address for all AMMI Canada Correspondence*

Work Address

Home Address(used only by secretariat)

Which email address would you like to use to login to the members only website*

Would you like to be listed in the AMMI Canada Membership Directory*(only accessible on the members only website)

Section/Specialty*(Check all that apply and indicate percentage of time)

Degree(s)*

Certification(s)

Employment Affiliation(s)*(Check all that apply and indicate percentage of time)

Primary Role(s)*(Check all that apply and indicate percentage of time)

Areas of Interest(Check all that apply)

Additional Information

Are you willing to speak to the media on behalf of AMMI Canada*

Are you interested in volunteering on a working group, committee etc.?*

Would you like to join the Clinical Research Network (CRN)*Additional Membership Dues are $200,this will be applied to your final invoice.

Why did you decide to join AMMI Canada?

Residents - Year of Study*

Medical Students - Year of Study*

Review

Application complete

Home Address
(used only by secretariat)

Would you like to be listed in the AMMI Canada Membership Directory*
(only accessible on the members only website)

Section/Specialty*
(Check all that apply and indicate percentage of time)

Employment Affiliation(s)*
(Check all that apply and indicate percentage of time)

Primary Role(s)*
(Check all that apply and indicate percentage of time)

Areas of Interest
(Check all that apply)

Would you like to join the Clinical Research Network (CRN)*
Additional Membership Dues are $200,
this will be applied to your final invoice.