ASTD Houston Chapter Membership Application


Section 1: My ASTD Houston Member Information
	First Name*

Last Name*

Initials

Company*

Position Title

Mailing Address*

City*

State*

Zip Code*

Country

Work Phone

Home Phone

Mobile Phone

Pager

E-mail*

User Name*

Password*

confirm password

E-mail 2

Web Site

Web Site 2

Hide in Search

Yes No

Hide Address

Yes No

Hide Email

Yes No

Hide Phone

Yes No


Section 2: Membership Information - Please note areas of expertise that you are willing to share with other ASTD members
	Corporate Membership ID n/a

	Referred By ASTD Houston Chapter Member

Referred by Other

Referral Source

Networking

Section 3: Membership Type

Membership Type*

	$369.00 - Conference Combo: New Member application with combined Conference Registration for the 2008 ASTD Houston Conference & EXPO.
	$125.00 - General Member:
	$65.00 - Senior Member: To qualify for this senior rate, one must be 65 years old, or older.
	$45.00 - Student: To qualify for this student rate, one must NOT be working in the workplace learning or training & development profession, but must be enrolled in either a formal academic program or certification curriculum.


Section 4: Payment
	Payment Method* Credit card Check Send invoice


Section 5: Subscribe to Newsletters and Groups
	Subscribe to groups ASTD General Newsletter Career Transition SIG Coaching SIG E-Learning SIG