To join the New York State Rheumatology Society, please fill out the form below. Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*FaxEmail* NYSRS Membership Status*New MemberCurrent Active MemberRenew MembershipI am interested in serving on the following committees: Managed Care Committee Meeting Program Committee Other I would like to chair a committee: Yes, I am interested in serving as Chairman of the Managed Care Committee Yes, I am interested in serving as Program Committee Chairman Our annual dues are $100. Please select your payment method below:*Pay OnlinePay By CheckPaying online will activate your member subscription to automatically renew your membership every 12 months*Please make check payable to New York State Rheumatology Society and mail your dues check to: New York State Rheumatology Societyc/o Amanda Ciardiello,150 Motor Parkway, Suite 108Hauppauge, NY 11788Product NameCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name