The International Society forLaser Surgery and Medicine(ISLSM)JOIN ISLSM!
Information and Application FormThe International Society for Laser Surgery and Medicine (ISLSM) is theoldest such society, having been formed in 1975 by the Founding President, Professor Isaac
Kaplan. In the intervening 3 decades plus, meetings have been held regularly worldwide
which have been well-attended, interesting and extremely informative. The society is open
to anyone working in the field of laser surgery, laser medicine, phototherapy andassociated research. All health care professionals with interest in any of the above fields areinvited to join the ISLSM, including but not limited to clinicians, dental surgeons,veterinary surgeons, nurse specialists, laser nurses, laser safety officers, and all paramedicalstaff.
The membership fees for the ISLSM are as follows. Recently, the Society voted to adopt thejournal Laser Therapy as its official organ, and ISLSM members can receive this journalfor no additional fee.
You may also join as a Life Member. Simply pay 10 years' fees in advance, and you will beenrolled as an honoured ISLSM Life Member.
So sign up today, and join the oldest association dedicated to all facets of photosurgery andphototherapy. Fill in and return the appropriate application form, together with thesupplement for the journal, and start receiving 4 issues of Laser Therapy per annum withimmediate effect.

Fee structure for ISLSM (in JPY)
ItemFee

ISLSM Admission Fee (Once only payment)
ISLSM Annual Dues
ISLSM Life Member ( < 60 years of age)
ISLSM Life Member ( 60 years of age and over)¥ 5,000¥ 10,000¥ 100,000¥ 40,000

Receiving
Free Journal
1 year10 years
4 years

The International Society for Laser Surgery and Medicine (ISLSM)
Membership Application Form
(Please Print or type clearly)

Name (Underline Last Name): ______________________________________________________________
Title (Mr, Ms, Mrs, Dr, Prof, etc): ________________ Degrees or Diplomas Obtained: _______________
Full Postal Address: _________________________________________________________________________________________________________________________________________________________

Phone (with country code): ____________________________ Fax: _________________________
E-mail: ___________________________________________________________________To the Treasurer, the International Society for Laser Surgery and Medicine (ISLSM):
I hereby apply for membership of the International Society for Laser Surgery and Medicine (ISLSM)
and pay: (tick as appropriate)□Admission Fee: ¥ 5,000□Life Member: ¥ 100,000 ( < 60 years of age)

□Annual Dues: ¥ 10,000□Life Member: ¥ 40,000 ( 60 years of age and over)

I understand that, as part of my membership privileges, I will receive 4 issues of the current volumeof Laser Therapy, the official journal of the ISLSM.

Kindly complete the following information, and send by FAX to +81-3-5269-1410.

Please debit my □Visa □Mastercard (tick as appropriate) by the sum of JPY ¥________________Card number: _____________________________________________________________________Name as it appears on the card: ______________________________________________________
Expiry date: (Year) 20________(Month)________

3-digit security number ______________

Cardholder’s signature: ___________________________________ Date: __________________For bank transfer within Japan, please contact the Treasurer, c/o Japan Medical Laser Laboratory
Phone: 03-5269-1403, Fax: 03-5269-1410, E-mail: lasertherapy@jmll.co.jp