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/