Online Individual Membership Application

INSTRUCTIONS: Please complete this form and submit by clicking the “Submit Your Application” button at the bottom of the page. After you’ve successfully completed all the form fields, return to the “Membership/Payments” page for payment information.

Prefix

First Name

Middle Initial

Last Name

Suffix

Position Title

Name of Institution

Campus

Office Phone

Office Fax

Office Address

Office City

Office State

Office Zipcode

Office Email

Home Address

Home City

Home State

Home Zipcode

Personal Email

Fees Per Category

Individual Professional Memberships - $50 Individual Student Membership - $10 Associate Membership - $100 Retiree Membership - $100

Membership Status

Continuing New Former

**Note: Once you have filled out all the form fields above and are ready to submit your application, you will need to return to the "Membership/Payments" page to complete STEP 2 (making your payment) or you can submit your payment at the bottom of the page. Submission of membership dues is the final step in completing the membership application.

Online Individual Membership Application

Please complete the Membership Application above and then submit payment below.