Illinois Society of Genetic Professionals

User ID

First name

Last name

Genetic Counselor

Preferred Email

Alternate Email

Phone

Designation

Address

Employer

Job Title

Specialty

Highest Level of Education

If other degree, please describe

University

Degree currently being pursued

If other, please describe

Other Professional Organization Memberships

Are you interested in learning more about the following committees/task forces?

Billing and Reimbursement Committee

Community Education Committee

GC Licensure Amendment Task Force

Symposium Committee

Marketing Committee

Membership Committee

Professional Group Outreach and Provider Education Committee

Are you able to have prospective students shadow and/or interview you?

If other interests, please describe

How did you hear about ISGP?

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