MABSA Membership Application

Name

Certification/Licenses

Degree(s)

Title/Position

Company/Organization

Address

Telephone

Fax

Email Address

Referred by

Individual Membership $20.00  

MABSA is open to all individuals interested in biosafety. If you wish to be a member, please complete this application by providing the information requested, as you would like it to appear in the membership directory.
Print the application and send with a check for $20.00 payable to MABSA, to the treasurer:

Scott Finkernagel

Weill Cornell Medical College
402 East 67th Street
Campus Box 354, Room LA-0020
New York, NY 10065
Fax. 646-962-0288
scf2002@med.cornell.edu