2003 INSTITUTIONAL MEMBERSHIP APPLICATION

International Society for
Quality of Life Research

Executive Office
6728 Old McLean Village Dr.	Fax: (703) 556-8729
McLean, VA 22101-3906 USA	Email: info@isoqol.org
Telephone: (703) 556-9222	www.isoqol.org

2008 INSTITUTIONAL MEMBERSHIP APPLICATION

Name of Institution/Corporation__________________________________________________________________

Contact Name____________________________________ Telephone Number____________________________

Address____________________________________________________________________________________

City____________________________ State___________ Zip Code____________ Country__________________

MEMBERSHIP FEES AND CATEGORIES
(Please choose type of membership)

Non-Profit Institutional Membership - Annual Contribution of $1,000

Eligible Members:
Benefits include:

Universities and non-profit organizations
Five (5) individual memberships;
Visibility among QOL/health outcomes researchers and the field;
Ability to post job advertisements in newsletter and on website for free;
Listing on website as an institutional member;
Special rates for booths at annual meeting.

Institutional Membership - Annual Contribution of $2,500

Eligible Members:
Benefits include:

Universities, contract research organizations and other companies
Five (5) individual memberships;
Visibility among QOL/health outcomes researchers and the field;
Ability to post job advertisements in newsletter and on website for free;
Listing on website as an institutional member;
Special rates for booths at annual meeting.

Corporate Membership - Annual Contribution of $5,000

Eligible Members:

Benefits include:

Pharmaceutical and medical device companies, health insurers and other companies
Five (5) individual memberships;
Visibility among QOL/health outcomes researchers and the field;
Ability to post job advertisements in newsletter and on website for free;
Listing on website as a corporate member;
Special rates for booths at annual meeting.

Corporate Sponsor Membership - Annual Contribution of $10,000 or more

Eligible Members:

Benefits include:

Pharmaceutical and medical device companies, health insurers and other companies
Ten (10) individual memberships;
Visibility among QOL/health outcomes researchers and the field;
Ability to post job advertisements in newsletter and on website for free;
Listing on website as a corporate sponsor;
Special rates for booths at annual meeting;

Method of payment: Check or money order in US funds payable to ISOQOL Master Card Visa

Name on card _______________________________________________ Expiration Date____________________

Credit Card Number _______-_______-_______-_______ Signature ____________________________________

Please complete the next page for individual membership information. ISOQOL's Tax ID number is 54-1985637

Name of individual member__________________________________________________________________

Title__________________________________ Highest Degree_____________ Male/Female_____________

Address___________________________________________________________________________________