Allergists for Israel - Membership Application

Chairperson:
Jonathan A. Bernstein, MD
Board of Directors:

Leonard Bielory, MD
John Cohn, MD

Gary Gross, MD
Michael Kaliner, MD
Jonathan Matz, MD
Nathan Segall, MD
Bernie Silverman, MD

IAACI:

Mona Kidon, MD

Menachem Rottem, MD

Webmaster:

David Rosenthal, DO

Admin. Assistant:

Beth Goldfarb

Treasurer:
Randee Mansfield
Founder (1984):
William Silvers, MD
Past Chairpeople:
William Silvers, MD
Lyndon Mansfield, MD

Allergists for Israel is a 501(c)(3) organization.

Last Updated 11/2/2011

Hosted by: 1and1

Allergists for Israel

2012 Membership Application

2012 annual dues are $118.

*Name MD DO PhD RN Other

Organization

*Street Address

*City State Zip

*Country

*E-mail

*Phone Fax

*Spouse/Partner’s Name

Hobbies/Affiliations

Member since

*Areas of interest

Please let us know what you are interested in seeing Allergists for Israel achieve. Your comments and suggestions will help us to improve our organization.

Our primary mode of communication will be e-mail since it is easy to use and inexpensive. Please let us know if you would rather be contacted via an alternate method. Phone Fax

2012 annual dues are $118. After you click the button below, you will be directed to on how to pay these dues.

For questions or comments, please contact Beth at afiadm@gmail.com

If you would rather, you can print the membership form and fax it in.

Thank you for taking the time to complete this form.
Randee Mansfield, Treasurer
Allergists for Israel
2121 Wyoming Ave., El Paso, Tx 79903
PHONE 915-544-2557
FAX 915-544-1817