Membership Application | Kaposis Sarcoma Herpesvirus (KSHV) and Related Agents Association, Inc.

Student Membership Application

$20 per year – Student Membership: shall be open to all graduate, undergraduate, or post-baccalaureate students, who are enrolled in a full-time academic program in medicine or the physical or biological sciences in an educational institution.

KAPOSI’S SARCOMA HERPESVIRUS (KSHV) AND RELATED AGENTS ASSOCIATION, INC:

2108 N. Street, Suite N
Sacramento, CA 95816 USA

KSHV Association Membership covers membership from January through December each year, with multi-year options available. Using the online membership site you will be able to update your profile, please consider including a profile picture and min-bio. If you believe our information is not correct, please contact the Managing Director. If you have changed your email address, please try using your past email address to login to avoid duplicate records.

Membership Dues

Your Dues Rate Type is: Student Membership: shall be open to all graduate, undergraduate, or post-baccalaureate students, who are enrolled in a full-time academic program in medicine or the physical or biological sciences in an educational institution. $20.00

Contact Information

Email *

Re-enter your email *

Prefix

First Name *

Middle

Last Name *

Suffix

Title

Informal Name

Pronouns

Institution/Company *

Address Line 1 *

Address Line 2

Address Line 3

City *

State

Zip Code *

Country *

Website

Personal LinkedIn URL or Handle

Personal X (Twitter) URL or Handle

Company LinkedIn URL or Handle

Company X (Twitter) URL or Handle

Phone Number *

Fax Number

CCMail

Include me in Membership Directories *
Yes No

Include me in Broadcast Email *
Yes No

Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

Please upload a document to verify your status as enrolled in a full-time academic program in medicine or the physical or biological sciences in an educational institution. * Allowed file types: doc,docx,pdf,ppt,pptx,xls,xlsx,txt,gif,jpg,png,jpe

Payment Details

Payment Method

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing Kaposis Sarcoma Herpesvirus (KSHV) and Related Agents Association, Inc. to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Kaposis Sarcoma Herpesvirus (KSHV) and Related Agents Association, Inc., or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

Name on Card

Card Number

Expiration

CSC

Billing Street

Billing Zip Code

PO #

Total Amount Due

The Kaposi's Sarcoma Herpesvirus (KSHV) and Related Agents Association, Inc. as a 501 (c) 3 non-profit organization. Membership dues and subscriptions paid to KSHV Association are not considered charitable contributions for federal tax purposes, however they may be deducted as ordinary and necessary business expenses. Members should consult their tax advisors for further guidance. The KSHV Association US Federal Tax ID # is: 33-2073831

For more information or assistance, please contact Joan Oefner, Managing Director, in the KSHV Association Management Office:

Kaposi's Sarcoma Herpesvirus (KSHV) and Related Agents Association, Inc.
2108 N. Street, Suite N
Sacramento, CA 95816 USA
email
www.ksvirus.org

Virtual Office of the Managing Director:
Joan Oefner, Managing Director
Regensburg, Germany
Tel or WhatsApp: +49 (0) 171-1049-181
email