ISMRT New National Chapter Petition Form

"*" indicates required fields

Your Name*
In order to form a National Chapter, a petition of at least 25 Members of the society, in good standing, of whom at least 15 are ISMRT Full Members (expatriates of the proposed chapter country/region are eligible to sign the petition, i.e., they may be temporarily or permanently residing in a country other than that of the person’s upbringing or legal residence; however, they must still hold citizenship in the relevant country or region in which the chapter is proposed), will need to be included.

Please attach the required document (download the template here) with the following information:

  • Members Full Name (First, M., Last)
  • ISMRT Member ID#
  • Membership Type (ISMRT Full, Early Career, Student or Affiliate or ISMRM member)
  • Email
  • City/State
  • Country of Residence

Note: If you have more than a few files to upload, please combine them into a single .zip file.

Drop files here or
Accepted file types: xls, xlsx, csv, doc, docx, rtf, txt, pdf, zip, Max. file size: 2 MB.

    Describe the governance model of your proposed chapter:

    • Size of governance committee (i.e., president, vice president, secretary, treasurer; ensure that governing members are ISMRT members per our "ISMRT Guidelines for Operations")
    • Length of term
    • Whether or not they are elected annually
    • How these members will be nominated
    • A description of what each position is responsible for
    Acting National Chapter Representative*
    Must be a full member of ISMRT in good standing.
    When will the first chapter election occur?*
    (for at least two (2) years following national chapter creation)
    (income/expenses)