Affiliate Membership Application

Please provide the name and contact information for the representative of the Society seeking Affiliate Membership Status with MDS. After you have submitted this information, a member of the International Secretariat will be in contact with you.

Please note: By submitting this form, you are simply noting your interest in becoming an Affiliate Society member of MDS and your application is not yet complete.  If you have any questions, please contact info@movementdisorders.org.

Required Application Materials (Please Upload Files Below):
  • Recent annual report of the activities of your organization or group
  • An organizational mailing list, to include e-mail addresses if available
  • A copy of your group's Constitution and Bylaws and/or documentation stating the structure of the organization
  • A copy of your group’s Objective(s) and Mission(s)
     

An asterisk (*) indicates required information

Society Contact Name*
Society Contact Role/Position*
Society Name*
Society Contact Company*
Company or Society Address*
Company or Society City*
Company or Society State/Province*

Company or Society Country*

Telephone*
Fax
E-mail*

 

 

NOTE: All executive members of your organization or group must be members of MDS.

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