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 ($125)
    • ASEP Certified Professional Member ($100)
    • Affilitate Member ($150)
    • International Member ($150)
    • Student Member ($50)
    • Fellow Member ($75)

Educational Background
Undergraduate:

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.   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/