American Thyroid Association. Scientists & Physicians Dedicated to Better Understanding & Treatment of Thyroid Diseases.

Membership Application

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Selection for membership in the American Thyroid Association is based primarily on:
1. Demonstrated interest in the pathology of the thyroid gland
2. Clinical and/or laboratory experience in thyroidology
3. Publications related to the thyroid
4. Attendance at meetings of the American Thyroid Association and other national thyroid meetings

Before applying, please review the Membership Guidelines and Membership Categories on the ATA web site, www.thyroid.org.

Also, please make sure to attach the required documents listed below before submitting this application.

Date (mm/dd/yyyy)
First Name
Last Name
Middle initial
Degree: M.D.
M.D., Ph.D.
Ph.D.
Other 

Applying for membership category:

Active (annual dues $285; includes subscription to the journal THYROID; add $35 for postage outside the US/Canada)
Corresponding (International Members – annual dues $95.00: Journal $260.00 – Includes postage)

Applicants for Corresponding membership: You must be an active member of (select one):

European Thyroid Association
Latin American Thyroid Society
Asia Oceania Thyroid Association

 Senior (annual dues $90.00; Journal $220.00; add $35 for postage outside the US/Canada)
 Associate (first-year annual dues waived; includes on-line access to THYROID); $50 after first year)

Institution/Office

Office Address


City
State
Zip Code/Postal
Country
Office Telephone
Office Fax
Office E-mail Address

Home Address

City
State
Zip Code/Postal
Country
Home Telephone
Home Fax
Home E-mail Address
Date of Birth (mm/dd/yyyy)
Gender
Female Male
Preferred address, phone, fax, and e-mail for ATA correspondence: 
Office
Home

License to practice

State/Province
Year
Name of Your ATA member Sponsor

Board certification:

Internal medicine

Endocrinology

Other (please specify)

Please check the ATA Annual Meetings you have attended:

Portland ' 98
Palm Beach ' 99
Kyoto, Japan ' 00
Washington D.C. ' 01
Los Angeles ' 02
Palm Beach ' 03
Vancouver ' 04
Spring Baltimore ' 05
ITC Buenos Aires ' 05
Spring DC ' 06
Phoenix ' 06
New York '07

Please submit your completed application along with following as attachments to this application

1. Your CV, including:

  • Academic college and year of graduation; medical or graduate school and year of graduation
  • Internship and residencies (include dates), postgraduate work (include dates)
  • Past and present professional and teaching appointments (include dates)
  • ATA annual meetings attended (list years)
  • Bibliography, emphasizing thyroid-related publications

2. Brief description of how your current professional activities reflect your interest in clinical thyroid disease or thyroid-related scientific investigation

3. Brief description of what motivates your desire to join the ATA

The Membership Committee reviews all applications and submits recommended candidates for approval by the ATA Executive Council three times a year. The list of accepted members is published in the SIGNAL newsletter and candidates are notified by mail of their acceptance. Dues will be invoiced upon acceptance of membership.

4. Letter of recommendation from an ATA member (If you do not know an ATA member, we will help you find one)

Attachments

Attachment 1 (CV)
Attachment 2 (Brief description of how your current professional activities reflect your intrest in clinical thyroid disease or thyroid-related scientific investigation)
Attachment 3 (Brief description of what motivates your desire to join the ATA)
Attachment 4(Letter of recommendation from an ATA member)
Attachment 5
Attachment 6
Attachment 7
Attachment 8
Attachment 9
Attachment 10
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