3. Person to contact regarding Association activities.

Name
Title
Phone
FAX
E-Mail

Will this person be appointed representative for voting purposes? Yes No

If no, please give the name of that representative:

REQUIRED BY REGULAR MEMBERSHIP APPLICANTS ONLY:

4. Professional qualified in testing and assessment on staff or under contract:

Name
Title
Phone
FAX
E-Mail

Educational background and professional affiliations of professional qualified in testing and assessment:

5. Types of tests developed, marketed, administered or interpreted by your firm (for regular membership applicants); or the products or services you provide to test publishers (for associate membership applicants.)

6. Please indicate the practice area committees in which your organization will participate. (Choose as many as applicable.) Please list a principal contact in each area:

Certification/Licensing
Contact: E-Mail

Clinical
Contact : E-Mail

Education
Contact: E-Mail

Industrial/Organizational
Contact:E-Mail

European
Contact:E-Mail

7. Please indicate the practice area from which your organization would stand for election to the Board of Directors. (Choose one.)

Certification/Licensing Clinical Education Industrial/Organizational European

An application for membership shall be deemed valid unless rejected by the Association Secretary, in which case the check shall be refunded and a letter of explanation mailed to the applicant. When the secretary ascertains that an application is valid, it shall be submitted it to the Board of Directors for its review and final acceptance.

As an individual authorized by my organization on these matters, if accepted for membership, I agree that my organization will abide by the Association's By-laws and any other professional or ethical standards adopted by the association and/or its practice committees.

Submitted by:

Name
Title

To submit this form electronically, click the Submit button. You will be billed for the membership fee.