Membership form

Required information is marked with an asterisk (*).

PERSONAL INFORMATION

Full Name (print)* : __________________________________________

E-mail address* :    __________________________________________

Education (degrees, subjects): ________________________________

Date of birth :     ___________________________________________

Nationality :       ___________________________________________


CONTACT INFORMATION

Phone number :   __________________________________________

Fax number :     __________________________________________

Personal website : ________________________________________

LinkedIn :       __________________________________________

Twitter :        __________________________________________

Facebook :       __________________________________________


PROFESSIONAL INFORMATION

Current Position :  _______________________________________

Language of publication : _________________________________

Employer :  _______________________________________________

Country* :  _______________________________________________

Address :   _______________________________________________

_______________________________________________

_______________________________________________


JOURNALISM INFORMATION
Are you a member of any other journalism associations?*
(if so, please indicate which & any offices held)




Do you regularly contribute articles to any publications?*
(if so, please indicate which)




Have you published any books?*
(if so, please indicate the publisher & ISBN)





Is there any extra information you wish to provide?
(If more space is needed, attach extra sheet.)






I, the undersigned, hereby apply for membership in the International Science
WritersAssociation and undertake to maintain its standards of conduct, to
accept its decisions, and to do all I can to advance the status of the
science-writing profession.

Signed :


Date :

Return to :

James Cornell, President
International Science Writers Association
6666 N. Mesa View Terrrace
Tucson, AZ 85718
Telephone: (520)-529-6835

After examination of the application by a membership committee, successful applicants will be notified of acceptance. Only then will a dues check for $25 (drawn on a US bank) or an international money order be requested to complete the membership process.