- Email: [email protected]
American Association of Medical Dosimetrists
Medical Dosrmetry, Vol. 15, pp. 4 1-44
0739-021 l/90 $3.00 + .@I Copyright 0 1990 American Association of Medical Dosimetrists
Printed in the U.S.A. All rights reserved.
Dates Received: Accepted: Rejected: Notified:
Flmerican Association of medical Dosimetrists
Amount: Class: MemberNo.: (Donotwritehere)
APPLICATION FOR MEMBERSHIP INSTRUCTIONS 1. Completetheapplication formas completelyaspossible. Mail the completed form and a check for $20.00 to: 2. Beth D’Emilia, Chairperson AAMD Membership Committee 892 Waterford Drive Delran, NJ 08075 The $20.00 application fee is non-refundable and is used to cover processing costs. 4. The AAMDMembershipCommittee andthe Boardof Directorswillreview yourapplicationandrecommenda specificmembershipclassification. Youwillbenotifiedoftheirdecisionbymail. billed for dues. Thepaymentofdueswillentitleyouto 5. Youwillthenbe aoneyear subscriptionoftheofficial AAMDnewsletterand journal, "MedicalDosimetry." 6. Informationwillbe senttoyouregardingthepurchaseofamembership certificate.
3.
MEMBERSHIPREQUIREMENTS MEMBERS:
Individualswhoareprimarilyandprofessionallyengagedinthe applicationofmedicalradiationdosimetrywithaminimumoftwo years of full-timeexperienceoroneyearofexperienceanda degree fromadosimetryormedicalphysicstrainingprogram. DUES: $65 per year
JUNIORMEMBERS:
1.)
Individualswhodo notprincipallyperformthe duties of amedicalradiationdosimetrist, butwho mayperformmanyoftheseduties ona routine professionalbasis. DUES: $50 per year 2.) Full-timedosimetristswithlessthantwoyears of experience. DUES: $50peryear
ASSOCIATEMEMBERS:
STUDENTMEMBERS:
Individualswhoareinterestedinthe fieldof medicalradiationdosimetry, butwhoareineligibleto beMembers OrJuniorMembers: DUES: 565peryear. Individuals enrolledina program. DUES: $30
formaldosimetrytraining
Individuals who failtomeetthese specific requirements, but can demonstrate adequate experience andtrainingwillbe considered for membership. Requirements for INACTIVE,HONORARY,ANDEMERITUSMEMBERSwillbe OnrequestbytheAAMDSecretary.
furnished
Please make checks payable to: American Association of Medical Dosimetrists Payable in U.S. Currency only.
Medical Dosimetry
42
Volume 15, Number I, 1990
All information must be typed or printed. For additional space use separate sheet. See instructions on first page. Dr. Mr. Mrs. Ms.
Middle
First
Last
Home Office
Address: (Pleaselist both) Directory listing forAAMDcorrespondence_
Office
City
State
Zip
Phone:
Phone: Birth Date:
Zip
State
City
ClassificationRequested Is this
a changeofclassification request?
Education: (Schools,colleges,universitiesafter high school) School/Address
Major
Dates
Deqree
Dates
Suoervisor
1.
2.
3.
4.
ProfessionalExperience:(Most recent first) Employer (City&State) 1.
2.
3.
4.
Title
AAMD Application for Membership
Dosimetry
Trainina:
Please give brief descriptionofwhen, where and howi.e., formal classes or OJT, you receivedyour dosimetrytraining.
List other professionalqualificationsand current activities relatedtoMedica1 Dosimetry inwhichyou are participating:
List scientificpapers or articles which you have published or are currentlyworking on: Title
Publication
1. 2. Indicateother organizationsrelated to radiation oncologyofwhichyou are amember: 3 n
Indicate areas in which youwouldlike
to become active as an AAMDmember:
Please answer the following questions:
1.
Besides yourself, howmanyother full-time dosimetristsare on staff
2.
Howmany Physicists areon staff
3.
Do you have an in-housecomputer for calculationsand treatment plans
If no, howaretreatment plans calculated
4.
Are you a full-time Dosimetrist? If no, plaseexplainyourinvolvementif any,withMedical Dosimetry.
43
Medical Dosimetry
44
Volume 15, Number 1, 1990
Please check the appropriate box forthelistedjob
responsibilities and assign a weight
factor (l-occasionally, Z-50%ofthetime, 3-mostofthetime) indicating the frequency if you occasionally cut patient beamblocks, then that task is performed byyou;.e.g., you would check
the "shared box" and indicate aweight of
1.
Not
Solely Respon.
Shared
Weight Factor
Respon.
Simulation and localization Patient treatment delivery Treatment planning Collection of patient data including contours &tumor volume Construction ofbolus, molds, bite blocks Construction ofcustomwedges compensators
and/or
Quality control of patient setup
Treatment dose calculations Beamblock fabrication Interstitial and/or intracavitary isodose calculations Handling and/or loading of radioactive sources Machine quality assurance TLD application References: (List names of two persons with whom you are professionally acquainted) I hereby certify that the above job responsibilities are, correct. Name
Job Title
Years Known
to the bestofmy
knowledge,
Signature
1. 2.
Please attach a job description to this application, or it will be returned to you. I herebycertifythatthe above information is, tothebest ofmy knowledge, correct. I agree to support and promote the aims of the AAMD.
Date
Signature
0739-021 l/90 $3.00 + .@I Copyright 0 1990 American Association of Medical Dosimetrists
Printed in the U.S.A. All rights reserved.
Dates Received: Accepted: Rejected: Notified:
Flmerican Association of medical Dosimetrists
Amount: Class: MemberNo.: (Donotwritehere)
APPLICATION FOR MEMBERSHIP INSTRUCTIONS 1. Completetheapplication formas completelyaspossible. Mail the completed form and a check for $20.00 to: 2. Beth D’Emilia, Chairperson AAMD Membership Committee 892 Waterford Drive Delran, NJ 08075 The $20.00 application fee is non-refundable and is used to cover processing costs. 4. The AAMDMembershipCommittee andthe Boardof Directorswillreview yourapplicationandrecommenda specificmembershipclassification. Youwillbenotifiedoftheirdecisionbymail. billed for dues. Thepaymentofdueswillentitleyouto 5. Youwillthenbe aoneyear subscriptionoftheofficial AAMDnewsletterand journal, "MedicalDosimetry." 6. Informationwillbe senttoyouregardingthepurchaseofamembership certificate.
3.
MEMBERSHIPREQUIREMENTS MEMBERS:
Individualswhoareprimarilyandprofessionallyengagedinthe applicationofmedicalradiationdosimetrywithaminimumoftwo years of full-timeexperienceoroneyearofexperienceanda degree fromadosimetryormedicalphysicstrainingprogram. DUES: $65 per year
JUNIORMEMBERS:
1.)
Individualswhodo notprincipallyperformthe duties of amedicalradiationdosimetrist, butwho mayperformmanyoftheseduties ona routine professionalbasis. DUES: $50 per year 2.) Full-timedosimetristswithlessthantwoyears of experience. DUES: $50peryear
ASSOCIATEMEMBERS:
STUDENTMEMBERS:
Individualswhoareinterestedinthe fieldof medicalradiationdosimetry, butwhoareineligibleto beMembers OrJuniorMembers: DUES: 565peryear. Individuals enrolledina program. DUES: $30
formaldosimetrytraining
Individuals who failtomeetthese specific requirements, but can demonstrate adequate experience andtrainingwillbe considered for membership. Requirements for INACTIVE,HONORARY,ANDEMERITUSMEMBERSwillbe OnrequestbytheAAMDSecretary.
furnished
Please make checks payable to: American Association of Medical Dosimetrists Payable in U.S. Currency only.
Medical Dosimetry
42
Volume 15, Number I, 1990
All information must be typed or printed. For additional space use separate sheet. See instructions on first page. Dr. Mr. Mrs. Ms.
Middle
First
Last
Home Office
Address: (Pleaselist both) Directory listing forAAMDcorrespondence_
Office
City
State
Zip
Phone:
Phone: Birth Date:
Zip
State
City
ClassificationRequested Is this
a changeofclassification request?
Education: (Schools,colleges,universitiesafter high school) School/Address
Major
Dates
Deqree
Dates
Suoervisor
1.
2.
3.
4.
ProfessionalExperience:(Most recent first) Employer (City&State) 1.
2.
3.
4.
Title
AAMD Application for Membership
Dosimetry
Trainina:
Please give brief descriptionofwhen, where and howi.e., formal classes or OJT, you receivedyour dosimetrytraining.
List other professionalqualificationsand current activities relatedtoMedica1 Dosimetry inwhichyou are participating:
List scientificpapers or articles which you have published or are currentlyworking on: Title
Publication
1. 2. Indicateother organizationsrelated to radiation oncologyofwhichyou are amember: 3 n
Indicate areas in which youwouldlike
to become active as an AAMDmember:
Please answer the following questions:
1.
Besides yourself, howmanyother full-time dosimetristsare on staff
2.
Howmany Physicists areon staff
3.
Do you have an in-housecomputer for calculationsand treatment plans
If no, howaretreatment plans calculated
4.
Are you a full-time Dosimetrist? If no, plaseexplainyourinvolvementif any,withMedical Dosimetry.
43
Medical Dosimetry
44
Volume 15, Number 1, 1990
Please check the appropriate box forthelistedjob
responsibilities and assign a weight
factor (l-occasionally, Z-50%ofthetime, 3-mostofthetime) indicating the frequency if you occasionally cut patient beamblocks, then that task is performed byyou;.e.g., you would check
the "shared box" and indicate aweight of
1.
Not
Solely Respon.
Shared
Weight Factor
Respon.
Simulation and localization Patient treatment delivery Treatment planning Collection of patient data including contours &tumor volume Construction ofbolus, molds, bite blocks Construction ofcustomwedges compensators
and/or
Quality control of patient setup
Treatment dose calculations Beamblock fabrication Interstitial and/or intracavitary isodose calculations Handling and/or loading of radioactive sources Machine quality assurance TLD application References: (List names of two persons with whom you are professionally acquainted) I hereby certify that the above job responsibilities are, correct. Name
Job Title
Years Known
to the bestofmy
knowledge,
Signature
1. 2.
Please attach a job description to this application, or it will be returned to you. I herebycertifythatthe above information is, tothebest ofmy knowledge, correct. I agree to support and promote the aims of the AAMD.
Date
Signature