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ASPSH Organization Membership Form

Organization Name: *

Address: *

City: *

Province: *

Postal Code: *

Key Contact (voting member) for ASPSH Membership:

First Name: *

Last Name: *

Position/Title:

Phone Number: *

E-mail: *

What type of membership is this?:

As an organizational member, you can designate nine other members of your organization who will also receive ASPSH informational e-mails and the membership rate for workshops and courses. Please list those members below including First Name, Last Name and E-mail. (If you are listing less than nine members, you can contact the membership coordinator at any time to add members).

List of Members::

How would you like to pay for your membership ($75 for 12 months):

Note: Payment options will be completed on the next page, after you click Submit.

Other Comments:

ASPSH

Primary links

ASPSH Organization Membership Form

Key Contact (voting member) for ASPSH Membership: