M E M B E R S H I P A P P L I C A T I O N

WWW.SNM.ORG/JOIN

IMPROVING HEALTHCARE BY ADVANCING MOLECULAR

IMAGING AND THERAPY. WITH AN EVER-EXPANDING

GLOBAL COMMUNITY OF 18,000 PHYSICIANS, TECH-

NOLOGISTS, PHARMACISTS, AND SCIENTISTS FROM MORE THAN

76 COUNTRIES, SNMMI CONTINUES TO EXTEND ITS REACH

AS A WORLD-CLASS LEADER IN THE ADVANCEMENT OF THE

SCIENCE, TECHNOLOGY AND PRACTICAL APPLICATION OF

NUCLEAR MEDICINE AND MOLECULAR IMAGING. A

PROMINENT COMMUNITY OF TOP PROFESSIONALS

AND A DEDICATED FOCUS ON YOU—THAT’S SNMMI.

JOIN TODAY.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is a scientific

and professional organization dedicated to advancing the science, technology

and practical application of nuclear medicine, molecular imaging and radionuclide

therapy.

For over 60 years, SNMMI members have developed—and continue to explore—

innovations in medical imaging to allow for noninvasive diagnosis, management

and treatment of diseases, benefiting countless patients. SNMMI’s 18,000 members,

in more than 76 countries around the world, include physicians, technologists,

physicists, pharmacists, scientists, laboratory professionals and others committed to

advancing nuclear medicine and molecular imaging.

Being a member of SNMMI offers you growth and continuing education that you won’t find anywhere else, along with the resources and connections to help your career flourish in the nuclear medicine and molecular imaging community. Our mission is to provide you with the tools you need to succeed:

World-Class Meetings• Collaborate with thousands of Nuclear Medicine and Molecular Imaging professionals at the SNMMI

Annual Meeting, Mid-Winter Meeting, SNMMI partnered meetings, local Chapter meetings, Roadshows and more• SNMMI members can save up to 40% off meeting registrations

Knowledge• The Journal of Nuclear Medicine (JNM)• Journal of Nuclear Medicine Technology (JNMT) – Exclusive SNMMI-TS Benefit• Uptake Newsletter – Exclusive SNMMI-TS Benefit• Smartbriefs – daily news briefing via email• SNMMI Website – Exclusive access to SNMMI’s website, which contains cutting-edge knowledge for optimal

patient care

Education• New! Free Journal SAMS• New! Member-only access to a state of the art MOC Part IV (Practice Performance Assessment) Tool, a library of

projects and templates and other resources• New! PET and NCT Online Review Workshops• Free CE Credits with SNMMI’s online journal exams• My Credit History Tracking• VOICE Program & Credit Sharing with ARRT & NMTCB – for Technologists• Access countless online education options that provide CME, AMA PRA Category 1 CreditsTM, VOICE, ACPE and

CAMPEP credit through the SNMMI’s Learning Center• Save up to 40% off numerous CE programs including our Online Lectures, Webinars, LLSAPs, Board Review course,

case studies and much more

Advocacy• SNMMI works closely with Congress, as well as federal departments and agencies like CMS, DOE, FDA, NRC,

etc., to ensure that nuclear medicine and molecular imaging is represented in the legislative and regulatory process and to get approval and availability of new tracers and technologies and appropriate reimbursement

• SNMMI’s Technologist Advocacy Group (TAG Team) provides a representative in every state to answer questions for members, monitor legislation, and lobby state governments when necessary

• HPRA Newsletter

Career & Professional Development• Maintain professional obligations and certifications• Search the job board, post a resume and access great resources on certification and licensure through SNMMI’s

Career Center• SNMMI provides over $300,000 annually in scholarships, awards and grants to members• Local chapters offer networking, education and opportunities to make a difference at the grassroots level• Get involved with SNMMI’s twelve specialty Councils and Centers of Excellence based on your interests

Resources & Tools• Practice Resources – Practice Guidelines, Appropriate Use Criteria, Nuclear Medicine & Radiation Dose Tool,

Credentialing statements, SNMMI’s Phantom program, Scope of Practice for the Nuclear Medicine Technologist and more

• Get up-to-date coding and reimbursement news or submit your Q & A through the online Coding Corner (www.snmmi.org/codingcorner)

• The Clinical Trials Network provides tools and resources to promote faster, more cost-effective drug development and increase the availability and performance of molecular imaging radiopharmaceuticals for use in the clinic

• Search and network with colleagues via our online member directory• Save up to 40% off books, products and merchandise from the SNMMI Store• The Affinity Programs provide exclusive services and products designed to enhance your lifestyle and your practice

M E M B E R S H I P B E N E F I T S

M E M B E R S H I P T Y P E S

SNMMI’s membership year runs from October 1 – September 30.

Full Member(Doctorate degree)

Physicians, scientists or pharmacists possessing an advanced degree who have presented credentials indicating their professional activity, either, medical, paramedical, investigational or educational in the scientific or clinical disciplines of molecular imaging or nuclear medicine. This includes the diagnostic, therapeutic or investigational use of radionuclides or other molecular imaging technologies.

Annual Dues:US & Canada: $435 + chapter duesInternational: $460

Includes subscription to JNM.Includes voting rights and can be elected an officer of the SNMMI.

Associate Member(Masters or Baccalaureate degree)

Scientists, or other health professionals with a masters or baccalaureate degree who have presented credentials indicating their professional activity, either paramedical, investigational or educational, in the scientific or clinical disciplines of molecular imaging or nuclear medicine. This includes the diagnostic, therapeutic or investigational use of radionuclides or other molecular imaging technologies.

Annual Dues:$295 + chapter dues

Includes subscription to JNM.Includes voting rights.

Associate Scientific Lab Professional(Masters or Baccalaureate degree)

Scientific Laboratory Professionals are individuals involved in molecular imaging research at the pre-clinical or translational level. These fields include utilization of optical imaging, radiopharmaceuticals, MRI,MR spectroscopy, ultrasound, stem cell research and cell trafficking. Members must have a master or baccalaureate degree and provide valid credentials indicating their training and involvement in one of these areas of research.

Annual Dues:$129 + chapter dues

Includes subscription to JNM.Includes voting rights.

Associate Technologist Member(Masters or Baccalaureate degree)

Nuclear medicine and molecular imaging technologists, with a masters or baccalaureate degree who have presented credentials indicating their professional activity, either paramedical, investigational or educational, in the scientific or clinical disciplines of molecular imaging or nuclear medicine. This includes the diagnostic, therapeutic or investigational use of radionuclides or other molecular imaging technologies.

Annual Dues:$121 + chapter dues

Includes subscriptions to JNM, JNMT, and Uptake newsletter.Includes voting rights in SNMMI and SNMMI-TS. Can be elected an officer of the SNMMI-TS.

Technologist Member

Technologists who have presented credentials indicating professional activity in molecular imaging or nuclear medicine technology or other related fields.

Annual Dues:$106 + chapter dues

Includes subscriptions to JNM, JNMT, and Uptake newsletter.Includes voting rights and can be elected an officer of the SNMMI-TS.

Scientific Lab Professional

Individuals who are involved in molecular imaging research at the pre-clinical or translational level. These fields include utilization of optical imaging, radiopharmaceuticals, MRI, MR spectroscopy, ultrasound, stem cell research and cell trafficking. Members must provide valid credentials indicating their training and involvement in one of these areas of research.

Annual Dues:$106 + chapter dues

Includes subscriptions to JNM, JNMT, and Uptake newsletter.Includes voting rights and can be elected an officer of the SNMMI-TS.

Affiliate Member

Individuals committed to the advancement of molecular imaging or nuclear medicine, but not qualifying for membership in other categories.

Annual Dues:$325 + chapter dues

Includes subscription to JNM.

Emeritus Member

Individuals upon their retirement after at least ten (10) years of consecutive membership in the Society. Please contact SNMMI member services for more information regarding Emeritus membership.

Annual Dues:Free (online journal)$115 (with print journal)

Includes an online subscription to JNM or JNMT.Includes a subscription to JNM or JNMT.

Resident/ Fellow

Nuclear Medicine or Radiology Residents/Fellows who are enrolled in accredited training programs or postdoctoral fellowships.

Annual Dues:Free during training

Includes online subscription to JNM.

Scientist-in-Training

Scientists who are enrolled in accredited training programs. Annual Dues:Free during training (up to 3 years)

Includes online subscription to JNM.

Technologist Student

Technologist students who are enrolled in accredited training programs Annual Dues:Free during training (up to 2 years)

Includes online subscriptions to JNM, JNMT, and Uptake newsletter.

In-Training Categories

Resident/ Fellow-in- Transition (1st year after graduation)

Residents/Fellows who participated in the society’s in-training membership program who graduated in the past 6 months, and can present credentials indicating professional activity in molecular imaging or nuclear medicine or other related fields.

Annual Dues:US & Canada: $217.50 + chapter duesInternational: $230

Includes online subscription to JNM.Includes voting rights and can be elected an officer of the SNMMI.

Scientist-in-Transition(1st year after graduation)

Scientists who participated in the SNMMI in-training membership program who graduated in the past 6 months, and can present credentials indicating professional activity in molecular imaging or nuclear medicine or other related fields.

Annual Dues:$147.50 + chapter dues

Includes online subscription to JNM.Includes voting rights and can be elected an officer of the SNMMI.

Technologist-in-Transition(1st year after graduation)

Students who participated in the SNMMI-TS in-training membership program who graduated in the past 6 months, and can present credentials indicating professional activity in molecular imaging or nuclear medicine or other related fields.

Annual Dues:$53 + chapter dues

Includes online subscriptions to JNM, JNMT, and Uptake newsletter.Includes voting rights and can be elected an officer of the SNMMI-TS.

In-Transition Categories

center for molecular imaging innovation and translation $15The Center for Molecular Imaging Innovation and Translation is an organizational component within SNMMI. The Center’s mission is to engage the molecular imaging community and leverage the SNMMI infrastructure to advance the adoption of emerging molecular imaging technologies and probes in preclinical and clinical applications. www.snmmi.org/cmiit

pet center of excellence $15The PET Center of Excellence is an organizational component within SNMMI that is dedicated to all aspects of the development and utilization of PET and PET/CT in the detection and management of disease. Two primary focuses of the Center are educational pro-grams and practical issues directly related to PET and PET/CT, including clinical practice, regulator issues, and reimbursement. The PET Center develops resources for referring and interpreting physicians through the PET PROS program (www.snmmi.org/petpros). www.snmmi.org/pet

academic council $15Promotes medical education, research and patient care; helps program directors and other educators develop better methods of teaching, and be better able to satisfy the requirements of accrediting bodies; provides a forum for an informal exchange of ideas and educational techniques. www.snmmi.org/academic

advanced associate council $10 Aids those who are interested in developing an NMAA program at their facility. Supports the practice and policy needs of the NMAA and other areas of technologist advanced practice. Aids with activities associated with nurturing and growing the NMAA, including effecting the necessary culture change to allow this designation to function properly. www.snmmi.org/aa

brain imaging council $15 Provides a forum whereby information relating to brain imaging may be discussed and disseminated and also provides a mechanism for the promotion and encouragement of basic brain imaging research and development. www.snmmi.org/brain-imaging

cardiovascular council $20 Committed to the advancement of Cardiac Nuclear and Molecular Imaging through the engagement of its members, outreach to the community, and advocacy across scientific and educational frontiers. www.snmmi.org/cardiovascular

computer & instrumentation council $15 Provides a source of information relating to computer and instrumentation science through meetings, seminars, and publications as well as promoting the advancement and dissemination of knowledge in this area. www.snmmi.org/caic

correlative imaging council $20 Provides a structure in which clinicians and scientists can develop and disseminate information on the medical and physiological applications of various imaging modalities as they correlate to nuclear medicine. www.snmmi.org/cic

general clinical nuclear medicine council $10 Increases the awareness of and enhances education about a wide range of clinical scintigraphic studies. Strives to achieve more universal standardization of these procedures. Specific focuses include pulmonary, renal, endocrine, musculoskeletal and gastrointestinal nuclear medicine studies. www.snmmi.org/gcnmc

nuclear oncology council $20 Fosters and encourages the scientific interchange of ideas among nuclear medicine professionals in imaging that utilizes radiopharmaceuticals, radiotherapuetic agents and related devices and who have an interest in expanding the use of radiopharmaceuticals for therapeutic purposes. www.snmmi.org/nuclear-oncology

pediatric imaging council $20 Provides a forum for individuals involved in pediatric scintigraphic imaging to meet and discuss common problems and experiences. www.snmmi.org/pediatric-imaging

radiopharmaceutical science council $20 Provides a forum for discussion and dissemination of information relating to the radiopharmaceutical sciences and promotes and encourages basic radiopharmaceutical research and development. www.snmmi.org/rpsc

C E N T E R S O F E X C E L L E N C E

C O U N C I L S

Members located in the United States or Canada must belong to one of the following chapters. Unless otherwise specified, a chapter will be automatically assigned based on your geographic location. The states and zip codes for each chapter are listed below.

Central Chapter(States: MN, WI, IL, IN, MI, OH zip codes 430-449 & 453-455 & 458)Full $40.00Associate $25.00Associate Scientific Lab Professional $40.00Associate Technologist $40.00Technologist $25.00Scientific Lab Professional $25.00Affiliate $25.00Resident/Scientist-in-Transition $5.00Technologist-in-Transition $5.00

Eastern Great Lakes Chapter(States: NY zip codes 128-132, 136, 140-149, Canada: Ontario and provinces east of Ontario)Full $30.00Associate $30.00Associate Scientific Lab Professional $30.00Associate Technologist $30.00Technologist $20.00Scientific Lab Professional $20.00Affiliate $30.00Resident/Scientist-in-Transition $5.00Technologist-in-Transition $5.00

Greater New York Chapter(States: NJ & NY zip codes 100-127, 133-135, 137-139, PA zip codes 170-196, CT zip codes 067-069)Full $50.00Associate $35.00Associate Scientific Lab Professional $50.00Associate Technologist $32.00Technologist $17.00Scientific Lab Professional $17.00Affiliate $35.00Resident/Scientist-in-Transition $2.50Technologist-in-Transition $3.50

Mid Eastern Chapter(States: MD, DE, VA, WV (except 260), DC)Full $30.00Associate $30.00Associate Scientific Lab Professional $30.00Associate Technologist $30.00Technologist $20.00Scientific Lab Professional $20.00Affiliate $30.00Resident/Scientist-in-Transition $5.00Technologist-in-Transition $5.00

Missouri Valley Chapter(States: MO, ND, SD, NE, KS, IA)Full $25.00Associate $25.00Associate Scientific Lab Professional $25.00Associate Technologist $21.00Technologist $16.00Scientific Lab Professional $16.00Affiliate $15.00Resident/Scientist-in-Transition $3.00Technologist-in-Transition $3.00

New England Chapter(States: RI, VT, ME, MA, NH, CT zip codes 060-066)Full $30.00Associate $30.00Associate Scientific Lab Professional $30.00Associate Technologist $10.00Technologist $10.00Scientific Lab Professional $10.00Affiliate $15.00Resident/Scientist-in-Transition $10.00Technologist-in-Transition $5.00

Northern California Chapter(States: NV zip: 893-898, 961, CA zip codes 936-961)Full $35.00Associate $25.00Associate Scientific Lab Professional $35.00Associate Technologist $27.00Technologist $22.00Scientific Lab Professional $22.00Affiliate $30.00Resident/Scientist-in-Transition $3.00Technologist-in-Transition $4.50

Pacific Northwest Chapter(States: WA, OR, ID, MT, WY, CO, UT, AK, HICANADA: British Columbia, Saskatchewan, Alberta & Manitoba)Full $35.00Associate $30.00Associate Scientific Lab Professional $35.00Associate Technologist $34.00Technologist $24.00Scientific Lab Professional $24.00Affiliate $30.00Resident/Scientist-in-Transition $2.50Technologist-in-Transition $4.50

Pacific Southwest Physicians/Technologist Chapters(States: AZ, NV zip codes 889-891, CA zip codes 900-935)Full $35.00Associate $25.00Associate Scientific Lab Professional $35.00Associate Technologist $12.00Technologist $12.00Scientific Lab Professional $12.00Affiliate $30.00Resident/Scientist-in-Transition $3.00Technologist-in-Transition $0.00

Pittsburgh Chapter(States: PA zip codes 150-169, WV zip code 260)Full $10.00Associate $10.00Associate Scientific Lab Professional $10.00Associate Technologist $20.00Technologist $15.00Scientific Lab Professional $15.00Affiliate $5.00Resident/Scientist-in-Transition $5.00Technologist-in-Transition $1.00

Southeastern Chapter(States: FL, GA, AL, MS, TN, SC, NC, KY, OH zip codes 450-452, 456-457)Full $40.00Associate $30.00Associate Scientific Lab Professional $30.00Associate Technologist $30.00Technologist $20.00Scientific Lab Professional $20.00Affiliate $30.00Resident/Scientist-in-Transition $0.00Technologist-in-Transition $0.00

Southwestern Chapter(States: NM, TX, OK, AR, LA)Full $30.00Associate $20.00Associate Scientific Lab Professional $25.00Associate Technologist $25.00Technologist $20.00Scientific Lab Professional $15.00Affiliate $25.00Resident/Scientist-in-Transition $5.00Technologist-in-Transition $2.00

S N M M I C H A P T E R S

For more information, visit www.snmmi.org/chapters

The Application Process1. Use the enclosed form on page 9 or complete an online application at www.snmmi.org/join.

All sections must be completed.

2. Residents and Students: In addition to completing an application you will also need to submit a program director certification form, which you can find on page 11 or by downloading a copy at www.snmmi.org/intraining.

3. Membership in SNMMI includes membership in one of 13 chapters for members in the United States and Canada where you can take an active part in local activities. Please refer to page 7 for a list of all the chapters.

4. Optional membership is available in various special interest groups. Please see page 6 for a complete listing.

5. Please complete the demographic information on page 10.

6. Submit the application along with dues payment to:

Society of Nuclear Medicine and Molecular ImagingAttn: Member Services1850 Samuel Morse DriveReston, VA 20190703.326.1186703.667.5134 (Fax)

SNMMI’s membership year runs from October 1 – September 30.

For questions about the application process, email us at memberinfo@snmmi.org, or call Member Services at 703.326.1186. Our hours are Monday – Friday, 9 a.m. – 5 p.m. ET.

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5 6

M E M B E R S H I P A P P L I C A T I O N

M E M B E R S H I P A P P L I C A T I O NFirst Name: M.I.: Last Name: Suffix:

Designations: Birth Date: Gender:

WORK ADDRESS:

Company/Institution:

Department: Title:

Street Address:

City, State, Zip: Country:

Work Email: Work Phone:

HOME ADDRESS:

Street Address:

City, State, Zip: Country:

Personal Email: Phone:

Preferred Mailing Address: q Home q Work Preferred Email Address: q Home q Work

MEMBERSHIP TYPE:Please select your appropriate member type below.q Full Member (US/Canada) - $435q Full Member (International) - $460q Associate Member - $295q Associate Scientific Lab Professional - $129q Affiliate Member - $325q Associate Technologist - $121q Technologist - $106q Scientific Lab Professional - $106q Resident/Fellow-in-Training - Freeq Scientist-in-Training - Freeq Technologist-in-Training - Free

ADDITIONAL MEMBERSHIP OPTIONS:Please select the Councils and/or Centers of Excellence to add to your membership.q Academic Council: $15q Advanced Associate Council: $10q Brain Imaging Council: $15q Cardiovascular Council: $20q Center for Molecular Imaging Innovation & Translation: $15q Computer & Instrumentation Council: $15q Correlative Imaging Council: $20q General Clinical Nuclear Medicine Council: $10q Nuclear Oncology Council: $20q PET Center of Excellence: $15q Pediatric Imaging Council: $20q Radiopharmaceutical Sciences Council: $20

I agree to abide by the current bylaws, policies and procedures of the Society and any future revisions thereof. I certify that the information given above is correct to the best of my knowledge.

Signature of Applicant: Date:

PAYMENT INFORMATION q American Express q Mastercard q VISA

Credit Card Number: Expiration Date:

Name as it appears on Card: Verification Code:

Cardholder Signature: Today’s Date:

q Check: Please make check payable to the Society of Nuclear Medicine and Molecular Imaging (in U.S. Dollars)

SNMMI’s membership year runs from October 1 – September 30.

Member Dues: $

Chapter Dues: $

Council/Center Dues: $

Total: $

CHAPTER MEMBERSHIP:Unless otherwise specified, a chapter will automatically be assigned based on your geographic location (members in US/Canada only).

Chapter:

PRINT PUBLICATION(S):SNMMI publications are now online. If you would like print issues, please opt-in below: Opt-inThe Journal of Nuclear Medicine (JNM) q

Journal Supplement(s) q

Journal of Nuclear Medicine Technology (JNMT) q

Uptake Newsletter q

M Y P R O F I L E

Full Name:

Please select your Continuing Education Credit Type:q AMA PRA Category 1 CreditsTM (Physician) q ACPE (Pharmacist) q VOICE (Technologist) q CAMPEP (Physicist) q None (In Training, Affiliate, etc)

Please select up to 3 certifications:q ABIM q None q ABNM q ABR q ARRT(CT)q ARRT(N)q ARRT(R)

Please select up to 3 certifications:q AAq AASq ASq BAq BSq BSCq DOq DScq JDq MB

Please select your job function:q Cardiology Technologistq Chief Technologistq Clinical Research Technologistq Consultantq Educator/Teacherq Healthcare Administratorq Medical Studentq Managementq Nuclear Medicine Physicianq Nuclear Medicine Technologistq Nurseq PET Technologistq Product Research & Developmentq Quality Management/Assuranceq Radiation Safety Officerq Radiographerq Radiologistq Radiopharmacistq Research Scientistq Residentq Sales & Marketingq Staff Technologistq Technical Directorq Technologist Studentq Other

Please select the best description of your workplace environment:q Combined Nuclear Medicine/Radiologyq Education in Classroomq Emergency Medicineq Family Practiceq Geriatricsq Internal Medicineq Molecular Imagingq Neurologyq Nuclear Medicineq Optical Imagingq Pediatricsq Pharmacyq Physicsq Radiologyq Veterinary Medicineq Other

Please select your primary specialty:q Cardiologyq Hybrid Imagingq Medical Physicsq Molecular Imagingq Molecular Probe and Contrast Agent Developmentq Nanomedicineq Nuclear Medicine (general)q Nuclear Medicine Technologyq Optical Imagingq Radiologyq Radiopharmaceutical Chemistryq Radiopharmacyq Other

Please select your primary place of work:q Academic Institutionq Departmental Libraryq Free-Standing Imaging Facilityq Government Laboratoryq Industryq Institutional Libraryq Military Clinic/Hospitalq Mobile Unitq Molecular Imaging Laboratoryq Non-University Affiliated Hospitalq Medical Centerq Other

q BCNPq NMTCB (CNMT)q NMTCB (NCT)q NMTCB (PET)q RPHq Other:

q MBAq MDq Medq MHAq MPHq MSq MScq PharmDq PhDq Other:

q None

M Y P R O F I L E

I hereby certify that _________________________________________, is currently a

__________________________________________________________________, enrolled in the

_________________________________program at_____________________________,

with an expected graduation date of __________________.

(PRINT NAME OF INDIVIDUAL)

(RESIDENT, FELLOW, SCIENTIST-IN-TRAINING, TECHNOLOGIST STUDENT)

(NAME OF PROGRAM) (NAME OF UNIVERSITY)

(MONTH/DAY/YEAR)

Signature: Date:

Name (Please Print):

Title:

WHAT CURRENT DEGREE PROGRAMS ARE YOU ENROLLED IN?

q AA

q BS

q MD

q PhD

P R O G R A M D I R E C T O R C E R T I F I C A T I O N(for in-training membership applications only)

q Other

TYPE OF RESIDENCY/FELLOWSHIP (IF APPLICABLE):

q Nuclear Medicine q Radiology

Please return to the SNMMI Membership Department at memberinfo@snmmi.org or by fax to 703-667-5134.

q MS

q Certificate

1850 Samuel Morse Drive Reston, VA 20190-5316

w w w . s n m m i . o r g