Membership Registration

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INET accepts applications for new members on an ongoing basis. Membership is open to all family physicians, as well as medical students and residents. Membership and participation in all research projects is voluntary. INET’s focus is on electronic data collection and transfer from remote sites, and translating research into practice at the point of care with the aid of PDA and web-based technology. If you would like to become a member, you can join online by completing and submitting the information below.

Last Name*
First Name*   M.I.
Office Address*
Office Address
City*
State*   Zip Code*
Email
Tel*    Fax

*Do you prefer to be contacted via Email or regular mail

YES! I would like to become a member of INET
YES! I would like to be added to INET's mailing list
YES! I would like to be added to the Department of Family Medicine's mailing list

Additional Comments:

(*denotes required field)