FUSUN Membership Application

FUSUN Membership

Membership Structure:

Membership is open to any organization that is a licensee of FujiFilm Medical Systems USA, Inc., actual users, or soon to be users of Fuji Synapse that are in good standing and that will support the purpose of FUSUN.
Membership is by institution. A FUSUN institutional membership allows up to five representatives per institution; the primary representative and four alternates. Changes in institutional representatives must be submitted in writing by the primary representative to the SIIM office.
- If an institution wishes to have more than five representatives, in total, from the same site, additional representatives may become members of FUSUN through the purchase of a supplemental membership. Each supplemental membership allows up to five additional representatives; however, the primary representative for the institution will not change. The annual dues for each supplemental membership will be 50% of the primary institutional membership dues.
- If an institution wishes to have more than one site within its system participate as a member of FUSUN, each additional site may join as a member separate from the primary institution, or as a supplemental member.
If a site joins as a member separate from the primary institution, representation will consist of one primary and four alternates, and annual membership dues will be paid by the institution at the rate appropriate to its institutional membership status with SIIM ($200 for non-institutional members/$100 for SIIM institutional members).
If a site joins as a supplemental member, representation will consist of up to five alternates; however, the primary representative for the institution will not change. The annual dues for each supplemental membership will be 50% of the primary institutional membership dues.

Membership Dues:

Thanks to the generous support of FujiFilm Medical USA, Inc., all new and existing Synapse institutions will receive a one-year complimentary membership upon receipt of a completed FUSUN membership application in the SIIM Office.

New Member - Complimentary 1st Year

SIIM Institutional Member - $100 USD

Non-SIIM Institutional Member - $200 USD

Membership Forms:

Membership Application

Membership Update Form

Apply Online Below

Name of Institution:
Department:
Address:
City:
State:
Zip:
Phone:
Fax:
Primary Representative:
Name:
Title:
E-mail:
Alternate Representative:
Name:
Title:
E-mail:
Alternate Representative:
Name:
Title:
E-mail:
Alternate Representative:
Name:
Title:
E-mail:
Alternate Representative:
Name:
Title:
E-mail: