IFMA Application for Membership

IFMA Application for Membership
1. Membership Information

To be considered for membership, all applications much be completed in full. If the application is approved, payment for the appropriate membership fees will be requested via the email address provided on the application. Applications can be submitted via US-mail, via email, or electronically at www.ifma-web.org. If submitting via US-mail or email, include the most recent copy of a resume or curriculum vitae (CV). The most current information must be included on this form and each section must be addressed unless otherwise noted. All application materials must be in English.
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
FAX Number

Country CodeArea CodePhone Number
Email*
example@example.com
Area(s) of specialization and research interests*
Total years of forensic experience*
Upload Resume or Curriculum Vitae (CV) *

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2. Directory Information

If you wish to publish different contact information in the membership directory than listed above, please complete the section below. If the information is the same, please only answer the first question.
I consent to having my contact information published in the membership directory.*

YesNo
Name

PrefixFirst NameMiddle NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Country CodeArea CodePhone Number
FAX Number

Country CodeArea CodePhone Number
Email
example@example.com
3. Personal Data Information

This information will not be published.
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemalePrefer not to disclose
4. Membership Status Requested
Member level*

FullAssociateStudent
Were you ever previously an applicant denied membership, student member, or associate member?*

YesNo
If yes, please explain below
5. Miscellaneous
How did you hear about the IFMA?*
Do you wish to have your name removed from any third party solicitations for member information the IFMA receives?*

YesNo
6. Current Education

Student membership application only. If applying as an associate or full member, proceed to section 7.
Institution Name and Location
Is the Institution Accredited?

YesNo
Degree and major(s) pursuing?
Date program of study started

MonthDayYear
Date
Expected date of completion

MonthDayYear
Date
Current enrollment status

Full timePart time
Classes taken via:

On CampusOnline/Distance EducationBoth
Plans after graduation (e.g. employment/career goals
Upload most recent transcripts

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7. Conferred Education

List highest ranking/earned degree first. If degree is in progress, list expected completion date.
List degrees in order of date
8. Certifications

List professional certifications below.
List certifications in order of date
9. Training

List the most relevant and/or recent training attended.
List training courses in order of date
10. Current Employment
Job Title*
Current Employer*
Current employment status*

Full timePart time
Date Started*

MonthDayYear
Date
Percentage of time dedicated to forensic medicine activities?*
Description of current job duties*
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Website
11. Ethical Conduct
Have you ever been censured for unethical conduct or procedure?*

YesNo
Have you ever been convicted of a felony?*

YesNo
12. Membership in professional and/or scientific societies

List only societies from which your membership is active.
List memberships in order of date
13. Publications

List the most relevant and/or recent publications.
List publications in order of date
14. Agreement

This application is only acceptable when completed, signed, and accompanied by the recommendation letter(s) as applicable. My signature below authorized IFMA or any of its officers to verity the accuracy of any of the information provided in or as part of this application. My signature is confirmation that I agree to adhere to the Code of Ethics and Conduct of the IFMA, whether as an applicant or member.
Code of Ethics and Conduct

As a means to promote the highest quality of professional conduct to its members, the following constitutes the Code of Ethics and Conduct which is endorsed and adhered to by all members and associates of the International Forensic Medicine Association.• Every Member and Associate of the IFMA shall refrain from exercising professional or personal conduct adverse to the best interests and purposes of the Association.• Every Member and Associate of the IFMA shall refrain from providing any material misrepresentation of education, training, experience, or area(s) of expertise.• Every Member and Associate of the IFMA shall refrain from providing any material misrepresentation of data upon which expert opinion or conclusion is based.• Every Member and Associate of the IFMA shall refrain from issuing public statements which appear to represent the position of the Association without specific authority first obtained from the Executive Board of Directors.
Applicant Signature*
Date*

MonthDayYear
Date
Total years of forensic experience*
Should be Empty:

IFMA Application for Membership

1. Membership Information

2. Directory Information

3. Personal Data Information

4. Membership Status Requested

5. Miscellaneous

6. Current Education

7. Conferred Education

8. Certifications

9. Training

10. Current Employment

11. Ethical Conduct

12. Membership in professional and/or scientific societies

13. Publications

14. Agreement

Code of Ethics and Conduct