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ACCOUNT PROFILE


Please complete the form below to create/update your account information. You may access/update this information at any time.

Username & Password


Please enter your desired account email address and password. The username and password entered may be sent to you in future emails.

*Account Email Address


*Password


*Re-type Password



Your Information


Please be sure to enter your email address correctly here. It will be used for account information retreival if you misplace your login details.

*First Name

Middle Name

*Last Name

Degree(s)

Position



*Contact Email Address


*Re-type Email Address



*Phone


*Certification:
 AP/CP
 AP
 CP
 Hematopathology
 Cytopathology
 Blood Banking/Transfusion Medicine
 Chemical Pathology

 Clinical Informatics
 Dermatopathology
 Forensic Pathology
 Medical Microbiology
 Neuropathology
 Pediatric Pathology
Other:


*Practice setting
 Private practice
 University-based medical center
 Research only
 Industry
 Trainee

Affiliation & Mailing Address


Please enter your affiliation and address information below.

Company/Affiliationn


Department


Street Address 1

Street Address 2

Street Address 3


City


State/Province


Country


Postal/Zip Code



Directory Information (members only)


All information in this section is optional and will listed in your membership directory profile, if you elect to make your listing available to fellow members.

Display My Profile in the Private Member Directory
Yes     No

Website URL
Twitter
Linkedin
Facebook

Profile Photo (members only)


You may use this section to upload a profile photo that will be displayed with your record in the membership directory. This step is optional. Please be sure to upoad your photo in JPG file format.


Max file size: 10Mb (jpg)








Society for Hematopathology
2111 Chestnut Avenue Ste 145
Glenview, IL 60025 USA

Email: info@society-for-hematopathology.org | Phone: (847) 235-6118 | Fax: (312) 896-5614