Application Categories
Active ($395.00 plus tax)
Member-in-Training ($50.00 plus tax)
Supporter ($60.00 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.

I Agree

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.

I Agree

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

Correspondence Information (For Secretariat use only, will not be published)

First name*
Last name*
Middle initial
Salutation:	--N/A-- Dr. Mr. Ms. Mrs.
Language of Correspondence*:	English Français
Gender:	Male       Female       Other       Prefer not to say
Institution/Organization name*
Department
Correspondence Address* (For Secretariat use only, will not be published)
City*
Province*	Please Select N/A Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Postal Code*
Country*
Telephone* (ex. +1 (555) 555-5555 x555)
Fax
Alternate/Mobile
Email address*
Assistant Name
Assistant email (used only by AMMI Canada Secretariat for scheduling purposes)

Directory Address

Do you want your address included in the online Directory, which is accessible to other members?* Yes No

Information About You (For Secretariat use only, will not be published)

Degree(s)*
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
--Please select-- MD PhD PharmD DVM MLT RN FRCPC FCCM FCSHP D(ABMM) C TropMed FAAP FACP FIDSA DTM&H DTM&T CCPE MSc MScPH MPH MEd MN CM BScPharm FAMMI
Other:

Section/Specialty* (Check all that apply):
Infectious Disease
Medical Microbiology
Internal Medicine
Clinical Microbiology
Other (ex. Pharmacy, Medical Laboratory Technology, etc.):


Paediatric*: Yes No

Credentials:




Fellowship or post-graduate training Institution(s):

Your Institution/Organization (For Secretariat use only, will not be published)

Primary employment affiliation:
University/Medical School
Hospital/Clinic
Community Laboratory
Federal Government
Provincial Government
Other:

Job Title:

Select primary role(s):
Clinical Infectious Diseases or Microbiology
Basic Research
Clinical Research
Public Health
Other:

Additional Information:
Would you be interested in participating in any of the following committees?
Antimicrobial Stewardship and Resistance Committee
Canadian Hospital Epidemiology Committee (CHEC)
Clinical Research Network
Communications and Public Relations Committee
Continuing Professional Development Committee
Grants & Awards Committee
Guidelines Committee
Indigenous Health Committee
Members-in-Training Committee
Paediatric Committee
Program Planning Committee

Do you wish to receive LISTSERV email messages from AMMI Canada?*†
(Please note that you may update your subscription preferences or unsubscribe at any time)
Yes – subscribe me to all LISTSERVs or indicate the type of messages you wish to receive
No – do not subscribe me to any LISTSERVs
† According to the AMMI Canada Bylaws, we are required to inform you of the annual general meeting and to send dues notices to you.
If you opt out of receiving these notices by email, we will be mailing these documents to you.
Please consider your consent to receive these documents so that you can be informed and help us keep our carbon footprint small.

Of the following, which do you consider to be your area(s) of interest?
Please select UP TO THREE, ranking your responses using numbers (1,2,3), listing your primary area of expertise as number 1.
1     2    3
Antimicrobial Stewardship and Resistance
Bacteriology
Basic Science
Education
HIV/AIDS
Infection Prevention and Control
Infections in Immunocompromised Hosts
Laboratory Safety
Molecular Microbiology
Mycology
Pharmacology of Antimicrobials
Public Health
Quality Management
Reference Microbiology
Sexually Transmitted Infections (STIs)
Translate Infectious Diseases
Tropical Disease/Travel Health/Parasitiology
Vaccines/Immunology
Viral Hepatitis
Virology
Other


Next

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.

I Agree

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:

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.

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.

I Agree

Review

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

Submit Application

Application complete

Merci. Votre candidature a été envoyée.