ISMRT New Division Petition Form

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Your Name*
In order to form a Division, a petition of at least 15 Members of the society, in good standing, of whom at least 10 are ISMRT Full Members, 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.
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    Describe the governance model of your proposed Division:

    • Size of governance committee (i.e., president, vice president, secretary, treasurer; ensure that governing members are ISMRT members per our "ISMRT Guidelines for Operations & Governance of ISMRT Divisions & Divisions Representatives")
    • 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 Division Representative*
    Must be a full member of ISMRT in good standing.
    YYYY slash MM slash DD
    (for at least two (2) years following division creation)
    (income/expenses)