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Membership Application and Renewal Form

 

 

I have read  APSIH's  statements of mission and objectives and submit the following information to apply for or renew my membership.  Please print out this page and mail along with your check to: APSIH P.O. Box 4175, Diamond Bar, California 91765, USA


Date

 

Application for (mark one)

Please see the qualification requirements:

 

Regular

Membership     0

 

 

Associate Membership     0

 

A-Regular Member,

1-Full-timefaculty with doctoral degrees engaged in educational or scientific research activities. These individuals should be employed by accredited educational institutions.

2-Full-timeresearchers holding doctoral degrees or equivalent, who are engaged in non-educational organizations.

B)  Associate Members

Part-time professors and scholars with a minimum education level equivalent to a graduate degree (MS / MA), engaged in universities or other accredited institutions of higher education.

Last Name

 

First Name

 

Organization

 

Position

 

Web Address

 

email address

 

Mailing Address

 

Street

 

City

 

     State

 

Zip

 

Country

 

 

Highest Degree

 

Field of Study

 

University

 

Reference (for New members)

 

                                                        Name

 

                                           Email address

 

 

APSIH Committees willing to serve:

 

Membership Committee:

 Chair: Dr. Sima Parisay 

 0

Research/Education Committee (includes Radio and Youth Mentorship  subcommittee):

Chair: Dr. Ali Akbari

 0

Fund Raising Committee (includes Scholarship subcommittee):

Chair: Dr. Mohammad Sangeladji

 0

Publications Committee (includes Web subcommittee):

Chair: Dr. Fleur Tehrani  

 0

Programs and Public Relations Committee (includes Events and Planning subcommittee):

Chair: Dr. Parvin Shahlapour

 

 0

        

 

 

 

Payments

 

 

 

Membership Dues 2007-2008

$35.00

Tax deductible Donation to the scholarship fund

      

Tax deductible Personalized Award for the Graduation Ceremony*

      

Total

      

 

 

* Please specify the name of the award and qualifications for the candidates.

 

 

I wish to establish an award in the name of:

 

 

 

 

 

 

 

Qualified candidates must be outstanding graduates in:

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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