Our Member Join Form is temporarily out of service. If you wish to join the CPSF, please call 312-431-9110 or email your information to cpsf@iomc.org. If you would like to become involved with the CPSF, please do the following:         1. Indicate your preferred membership category.             (click here for descriptions)         2. Indicate any CPSF special initiatives in which you are interested.             (click here for descriptions)                 3. Indicate any service areas in which you may be interested in assisting             CPSF.         4. Fill in your contact information.         5. Indicate if you would like to make a donation to CPSF.         6. Press submit.        * Required Fields

*Membership Category (please check only one) Special Initiatives (please check all that apply) Service Area (please check all that apply) Council of Organizations Professional Council Scientific Council Patient/Consumer Council Friends of the Forum   Illinois Patient Safety Organization Ambulatory Care Medication Safety Pediatric Patient Safety Infection Prevention Virtual Journal Club Membership Development Special Initiative Development Fundraising Annual Scientific Conference Planning Salutation Dr. Mr. Mrs. Ms. *First Name   Initial *Last Name   Degree(s) *Title *Organization *Address 1 Address 2 *City   *State   ZIP +4 Phone  Extension Fax *Email Comments     This information will be used to notify you of CPSF meetings, workshops, and initiatives that may be of interest to you.  It is gathered for the express use of the CPSF.  We will not sell, rent, or otherwise distribute this information.  CPSF primarily communicates  through email.  Please add cpsf@iomc.org to your email safe list.     How did you find out about us? Word of mouth? Internet search? Newspaper/Magazine/Radio/Television? Website link?     Donations are welcomed. 250 100 50 Other: $ Please make your donation checks payable to "Chicago Patient Safety Forum" and mail them to: Chicago Patient Safety Forum Attn: Steve Maxwell 332 South Michigan Suite 525 Chicago, IL 60604   When we receive your check, your name will be added to our sponsors page in our acknowledgments section. Thank you very much.