Student Affiliate Application

Applications must include the signature of a faculty advisor to verify your student status.
Student Affiliate dues are $25.00. Payment must be in U.S. funds by check, money order, or credit card (Visa, MasterCard, or American Express only).
Dues payment covers a subscription to TIP (The Industrial-Organizational Psychologist), the SIOP Membership Directory, the Conference Call for Proposals, the Conference Program, other mailings, discounts on selected publications, and reduced rates for the Annual Conference and Workshops are also provided.
The SIOP dues year runs from May to April. Annual renewals are sent to members and affiliates each April.

MAILING ADDRESS (Please print)
Name:________________________________________________
Street address:____________________________________________________
City:____________________________ State:________________ Zip:___________-_________ (please include zip+4)
E-mail: _________________ Phone:_______________________

EDUCATIONAL INFORMATION
Name of institution:________________________________________________
Area of specialization/major:________________________________________
Degree you are pursuing (e.g. PhD, MS, etc.): ____________
Year you expect to graduate: _____________
Advisor's name (please print): ______________________________________
Advisor's signature: ___________________________ Date_______________

APPLICATION MUST BE SIGNED BY AN ADVISOR IN ORDER TO BE PROCESSED

PAYMENT METHOD
__ Check __ Money Order __ Visa/MasterCard/American Express
Charge to card number:_______________________ Expiration date:________
Name on card:___________________________________
Cardholder signature: _____________________________________

MAIL APPLICATION WITH DUES PAYMENT TO:
SIOP Administrative Office • PO Box 87 • Bowling Green OH 43402-0087

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