Membership Checkout

Thank you for choosing to become a member of CSAM-SMCA! Please use the form below to create a CSAM-SMCA membership account. The first step is to choose a username and login if you are new to CSAM-SMCA. You will use these login details to update and manage your CSAM-SMCA membership anytime. If you already have a CSAM-SMCA account, please login to simplify your renewal. The information you provide will never be shared.

Membership Level change

You have selected the Student Membership (Associate Member) membership level.

The price for membership is $0.00 now.

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Account Information Already have an account? Log in here

Username

Password

Confirm Password

Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! ” ? $ % ^ & ).

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

Contact Information

First Name

Last Name

Please Provide Your Preferred Mailing Address.

Street Address

City

Province/State

Postal Code/Zip Code

Country

Phone
e.g. 555-555-1234

Personal Web Page
e.g. https://csam-smca.org

LinkedIn
e.g. https://www.linkedin.com/in/username/

Twitter
e.g. https://twitter.com/username

Professional Information

Please describe your involvement in addiction medicine

Health Care Discipline

FRCP/S Other

PhD Other

Other

Please provide information for the directory to accompany your listing, such as place of employment, current position, associations and affiliations, areas of interest, etcetera

I consent to have my Name, City, Province, LinkedIn and Twitter Profiles, Area of Specialty and Biography published in the CSAM-SMCA online directory. Beyond this limited use, CSAM-SMCA will never sell or share your personal information. I understand that the details I’ve provided here will be used to support the operation of the society and to send me emails and updates regarding the work of the society and my membership.

Payment Information We accept all major credit cards

Card Number

Expiration Date

CVC

Discount Code

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