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*****SENIOR MEMBERS PLEASE FILL OUT THIS SECTION*****

Name: __________________________________________

Organization: ____________________________________________

Mailing address: __________________________________________________

City/State: ___________________________________  Zip code: ___________

Phone: ________________________    Email: __________________________

Type of employment (e.g., academic, consulting, industry, etc.) ______________

Topical interests/Areas of specialty (e.g., selection, diversity, coaching, etc.):

_______________________________________________________________

Degree type: (e.g., M.A., M.S., Ph.D., DBA, Psy.D., etc.) ______________________________

Degree area: (e.g., I/O, OB, HR, Social, Clinical, etc.) _________________________________

Are you an ethnic minority?* Yes ____   No ____  If yes, specify ethnicity:  _______________

*NOTE: Ethnicity will only be used for matching purposes in case a junior
member prefers to be matched with someone from a similar ethnic background.  

*****JUNIOR MEMBERS PLEASE FILL OUT THIS SECTION*****

Name: __________________________________________________________

Organization: ________________________________________________________________

Mailing address: __________________________________________________

City/State: _________________________________  Zip code: _____________

Phone: ________________________    Email: ___________________________

Type of employment (e.g., academic, consulting, industry, etc.): ______________

Topical interests/Areas of specialty (e.g., selection, diversity, coaching, etc.):

_________________________________________________________________

Please indicate if you have specific preferences for a senior member (e.g., degree level   M.A., Ph.D., etc.; degree area I-O, HR, OB, Clinical, etc.; ethnic minority specify ethnicity preference): ________________________________________________________________

Note: Although we cannot guarantee a perfect match on all of your preferences, we will do our best to match senior and junior members on as many criteria as possible.

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