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/