AMERICAN SOCIETY OF EXERCISE PHYSIOLOGISTS

MEMBERSHIP APPLICATION


Biographic Information

Full Name (please print)                                                                   (PhD/MS/BS/none) circle one


Phone: (work)


FAX:                                                                            email:


Address:



Application Fee
Identify one of the following and enclose a check payable to ASEP:
    • Professional Member ($150)
    • ASEP Certified Professional Member ($125)
    • Affilitate Member ($150)
    • International Member ($150)
    • Student Member ($50)
    • Fellow Member ($100)

Educational Background
Undergraduate: (BS, BA, etc)

Institution


City/State
 

Dates Attended /Completed


Degree /Emphasis



Graduate: (MS, MA, etc)

Institution


City/State


Dates Attended/Completed


Degree /Emphasis



Graduate: (PhD, MD, etc)

Institution
 


City/State


Dates Attended /Completed


Degree /Emphasis



 
 
 Agreement

I hereby apply for membership in the American Society of Exercise Physiologists, and agree to abide by its Charter and objectives. I understand that ASEP may make inquiries about academic credentials for the purpose of verifing information in this application. I pledge myself to standards of ethical practice and conduct as specified in the ASEP Code of Ethics.  I certify that the above information is accurate, and I understand that inaccurate information can invalidate my application.

Signature                                                         Date   

________________________                           ______________________


The Professional Organization of Exercise Physiologists
http://www.asep.org/