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.
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.
Member Information
First name*
Last name*
Middle initial
Salutation:
--N/A--
Dr.
Mr.
Ms.
Mrs.
Suffix
Language of Correspondence*:
English
Français
Date of Birth (YYYY-MM-DD):
N/A
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
N/A
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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)
English
Français
What is your main language at work*
English
Français
Bilingual (English/Français)
Other
Preferred address for all AMMI Canada Correspondence*
Home
Work
Work Address
Institution/Organization name*
Department*
Position Title*
Room #
Street Address*
City*
Province*
Please Select
Other
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*
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
*
Please Select
Other
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
*
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)*
--Please select one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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 one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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 one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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 one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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 one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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 one--
MD
PhD
PharmD
DVM
Registered Laboratory Technologist
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:
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?
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:
Residents - Year of Study*
--Please select one--
PGY1
PGY2
PGY3
PGY4
PGY5
PGY6
Medical Students - Year of Study*
--Please select one--
1
2
3
4
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:
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
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
.