CTRMS is a Section of

MEMBER BENEFITS:n Reduced registration for biennial meetings (savings of $220)

n 50% discount off publication charges forCell Transplantation: The Regenerative Medicine Journal

n Access to the CTRMS online Membership Directory

n Voting and Nomination Rights (Full Members)

n CTRMS Members receive a $50 discount off TTS Member dueswhen paying both a the same time

Apply online today! www.tts.org/ctrmsFor more information please email:membership@tts.org

The Cell Transplant and Regenerative Medicine Society exists to be the leader indeveloping and translating safe cellular and regenerative therapies to patients.The Society will promote research, collaboration and focus on regulatory mattersas they relate to clinical translation.

JOIN TODAY!...and become part of the growing network

of cell transplant specialists.

Cell Transplant and Regenerative Medicine

Society

Full | $75 US • 1 year / $130 US • 2 yearsTrainee / Allied Health / Technical | $50 US • 1 year / $ 80 US • 2 years

MEMBERSHIP CATEGORIES

MEMBERSHIP APPLICATION Cell Transplant and Regenerative Medicine Society

SELECT MEMBERSHIP CATEGORY*

Full Membership n $ 75.00 US • 1 Year | n $ 130.00 US • 2 Years

Trainee Membership n $ 50.00 US • 1 Year | n $ 80.00 US • 2 Years

Allied Health n $ 50.00 US • 1 Year | n $ 80.00 US • 2 Years

Technical n $ 50.00 US • 1 Year | n $ 80.00 US • 2 Years

Payment Information

n VISA n MasterCard n Cash n Cheque

Card Number: Expiration Date (MM/YYYY):

Cardholder Name:

Signature:

505 René-Lévesque Blvd. W, Suite 1401, Montreal, QC H2Z 1Y7 CANADA | Tel: +1-514-874-1717 | Fax: +1-514-874-1716 | Email: membership@tts.org

*First (Given) Name: *Last (Family) Name:

*Institution/Affiliation: *Position Held:

Address:

City: Prov/State:

Postal Code: *Country:

Tel: Fax:

*Email:

*Sex: Male n Female n

*Date of Birth: *City and Country of Birth:

Degree(s): MD n PhD n Other (Please Specify):

Percentage of Time Spent on: Clinical | % | Research | % | Other | % |

YOU MAY ALSO APPLY DIRECTLY ONLINE AT WWW.TTS.ORG/CTRMS* - MANDATORY FIELDS

n Physiciann Scientistn Surgeon

n Nursen Lab Techniciann Organ Procurement Personnel

n Professional Association Personneln Industry / Marketingn Trainee

n Pharmacistn Transplant Coordinatorn Other:

CHECK THE BOX THAT BEST DESCRIBES YOUR PRIMARY ROLE (CHECK ONE):

n Industryn Government Agency

n Private Practicen Research Foundation

n Medical School/Universityn Military

n Other:

AFFILIATION TYPE (CHECK ONE):

n Allied Health Areasn Allotransplantationn Bio-Artificial Cells and Organsn Bone Marrown Cell Transplantationn Critical Caren Diabetesn Endocrinologyn Education and Teachingn Ethics, Economics & Quality of Life

n Experimental Transplantationn Gastroenterologyn Heart, Heart/Lung, Lungn Hepatologyn Histocompatibility & Immunogeneticsn Immunobiologyn Immunosuppression - Clinicaln Immunosuppression - Experimentaln Internal Medicinen Infections

n Isletsn Kidneyn Liver and Intestinen Nursingn Nutritionn Organ Procurement & Preservationn Pancreasn Pathologyn Pharmaceuticsn Radiography / Medical imaging

n Regenerative Medicinen Surgery - Heartn Surgery - Livern Surgery - Lungn Surgery - Pancreasn Surgery - Renaln Tx in Developing Countriesn Transplantomicsn Urologyn Xenotransplantation

AREAS OF INTEREST (CHECK ALL THAT APPLY):

In order to ensure that you don’t miss out on important membership benefits, we will be offering automatic membership renewal starting in 2020.

n DISCOUNTED 2-YEAR RATE - Please renew my membership automatically every 2 years | $130 (discounted rate)n REGULAR RATE - Please renew my membership automatically every year | $75n Please NO NOT renew my membership automatically and charge me only for this year | $75