Thank you for joining ANTSHE.  Please provide the following information to complete your membership application.

• Please provide the following information:
      Please use the mailing address you wish to receive ANTSHE materials at:

  Name
  Title
  Organization
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Cell Phone
  Home Phone
  FAX
  E-mail
  Your Current Status	Student Academic Professional Staff Professional Grad. Student Other
  School Website:

• Please select the type
  of membership you need: Student Friend Academic Professional Organizational Institutional Alumni Explain Other

• For information on the different types of membership look here

• Please provide information about your college, university, or Nontrad Club

• Name of School
  Student or Employee
  Nontrad Club Name
  Club or Org. Address
  Address (cont.)
  City
  State/Province	None Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
  ZipCode
  Club Webpage
  Current Club President
  Presidents Email
  Attended past ANTSHE Conference	Yes  No
  Planning to Attending Future?	Yes  No

  Institutional Membership allows for 3 Academic Professionals and unlimited active students as a benefit of joining.  If you are joining under this membership type please list additional members here. If you require more room please submit the student members information on a separate sheet and
  email it to [email protected]

  Name - Email - Phone
   

  Please indicated Payment Method: PayPal Mail In Check Organizational Check Institutional PO

  Please type in ANTSHE (all caps) to help prevent spam:    

Please verify the information you listed above and use the 'submit form' button when finished.