Southern Wisconsin Membership Application

ACRP OF SOUTHERN WISCONSIN

A CHAPTER OF THE ASSOCIATION OF CLINICAL RESEARCH PROFESSIONALS

LOCAL MEMBERSHIP APPLICATION 2008

MEMBERSHIP PERIOD 1/08-12/08

The Association of Clinical Research Professionals of Southern Wisconsin, Ltd has among its goals to:

• Provide a means for professional interaction, continuing education, problem-solving and discussion among ACRP members
• Increase the opportunity for member participation in ACRP activities
• Provide a mechanism for regional program development
• Provide a network for member feedback to ACRP on issues of concern

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NAME_________________________________________

TITLE_________________________________________

E-MAIL________________________________________

Are you interested in helping our chapter with meetings?

Check here_____

Are you interested in becoming a board member of our chapter?

Check here_____

Signature ____________________________________ date______

Chapter dues of $25.00 must accompany this application.

Please mail application and check made out to ACRP of Southern WI to:

Laura Wollenweber
ACRP of Southern WI
2561 Fox River Circle
Waukesha, WI   53189

Any questions? Call 414-955-8970 or e-mail:

lauraw@mcw.edu
zmassey@enzy.com
nnimphiu@mcw.edu
Jennifer.fink@aurora.org