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.