Academy Member Registration

First Name *

Last Name *

Position *

Institution

Address *

City *

State/Province *

Phone *

Email Address *

Membership Details

About Pacific Crest Invitee Membership:

Please note that "Pacific Crest Invitee" membership is only available for 60 days from the date of the Pacific Crest Institute you are attending (before or after). For example, if you will be attending a Teaching Institute on May 1, you have from March 2 (60 days before) to June 30 (60 days after) to take advantage of the Academy membership offer as a "Pacific Crest Invitee". This type of membership is a one-time option. It cannot be renewed by attending another Institute. To renew your membership, choose Regular or Student.

About Membership Tax Deductions:

For new regular members, $40 is tax-deductible. For renewing regular members, $60 is tax-deductible.

Membership type (select one): *

Is this membership a RENEWAL? *

Yes

No

Please provide the name of the primary contact at the institution. *

Please provide the date, name, and location of the institute you have or will attend (applies to Pacific Crest Invitee memberships only) *

If you'd like to make a donation, please enter the amount

Terms and Conditions *

As a member of the Academy of Process Educators, I consent to receive communications from the Academy electronically. The Academy will communicate with me by e-mail or phone. I agree that all agreements, notices, disclosures and other communications that the Academy provides to me electronically satisfy any legal requirement that such communications be in writing.

Institutional Membership ($375)	Regular membership ($70)	Student membership ($35)
Pacific Crest invitee ($35)	None; donation only