Associate Membership Application Form

Name: __________________________________________________

Preferred title: ____________________________________________

Job Title: ________________________________________________

Mailing Address:

________________________________________________________

________________________________________________________

Phone: (work) ___________ (home) ____________ (fax) ___________

E-mail address: ___________________________________________

Current CPA or APA status: ___________________________________

Other Professional Affiliations: ________________________________

Educational Background:

Highest Degree earned: _____________________________________

Year Degree attained: _______________________________________

Institution granting degree: ___________________________________

Research Interests/Area of Expertise

1. _______________________________________________________

2. _______________________________________________________

3. ________________________________________________________

I certify that the above information is correct and authorize the investigation of all statements contained in this application. I subscribe to and will support the mission of CSIOP as outlined above.
 

__________   ___________________________________
Date               Applicant Signature

Please send the completed application form and cheque or money order for $35.00 made payable to CSIOP in Canadian funds to:

Dr. Aaron Schat
DeGroote School of Business
McMaster University
1280 Main Street West
Hamilton, ON
Canada, L8S 4M4
 

You will be notified as to your membership status. After payment of your dues, you will be placed on the membership roster of the Canadian Society for Industrial and Organizational Psychology (CSIOP).