SNIS Member Reinstatement Form

Has your SNIS membership expired and you're interested in rejoining the Society? Please fill out your information below and our membership team will follow up with the next steps.

Please note that if you are no longer eligible for your previous membership level, you may need to submit a new application to reinstate your membership.

Fields marked with an * are required.

Member Information

First Name *

Last Name *

Email *

Phone *

Phone Type

Address Line 1

Address Line 2

City

State

Postal Code

Country

Training Level *

Former Membership Type (Senior, Junior, Medical Student/Resident, etc) *

If you don't remember you can leave this blank.

Additional Comments

Please verify that you have checked the “I'm not a robot” checkbox.