美国式禁忌:APS New Member Form

Printable New Member Form

* All Bolded fields are required.
Member Information
If you ever have been an APS Member, please Login to retrieve your current contact information and renew your membership. You can use the "Forgot Your Member ID" link on the Login page if you do not know your member ID.
Prefix: (Example: Dr, Mr, Ms, Mrs, Miss, or military rank)
*First Name:
Middle Initial:
*Last Name (Surname):
Suffix: (Example: Sr, Jr, III, IV)
(Place of Employment or University.)

Contact Information
* Address Type:
*Street Address:
US State:
Zip/Postal Code:
Non-US State/Province:
Cell Phone:

Opt in to receive text notifications:

Office Telephone: (Example: 555-123-4567 x890)
Home Telephone:
*Email Address:
Personal Web Site:
(Example: http://www.mysite.edu/dept/mypage.html)

Demographic Information

This information will help us better understand and serve the needs of APS Members. All information will be reported in aggregate. No information about an individual will be shared with a third party.

* Major Field:
Please select one or more major fields of study. You may rank your selections using the "Up" or "Down" buttons
Specialty Area(s): (i.e., Autism, Language and Memory, Consumer Psychology, etc)
Degree Institution:
*Highest Degree Completed: *Year Awarded:
Expected Degree (for students): Year Expected:
Date of Birth: (Example: mm/dd/yyyy)
(For APS use only: will not be published or released)
Employment Sector:
Please select one or more Race/Ethnicity choices.

Promotional Code
If you are taking advantage of a special promotion, please enter your code below:
Promotional Code: