Membership
Application form
For Membership renewal click here
Print
out and complete the following form. All dues must be paid in U.S. currency.
If currency regulations prohibit payment in U.S. dollars, use United Nations
vouchers. Check the category of membership (annual dues in parentheses)
for which you are applying for:
Membership dues can now be paid via paypal below:
___________________________________________________________________________
Full Name
___________________________________________________________________________
Mailing Address
___________________________________________________________________
City State/Province Zip or Post Code
__________________________
Country
__________________________
email address
_____________________________________________________________
Highest Degree Year Granting Institution
_______________________________________________________
Present Position (Title) Institution
Research
interests in relation to dermatoglyphics: (please circle)
anatomy anthropology clinical genetics epidemiology human biology
law neurology population genetics primatology virology
*To
be considered for election as a Fellow, please enclose a curriculum vitae.
**To be considered for student membership, the following must be completed.
__________________________________________________________________
Signature of Instructor or Registrar Title
_____________________________________
Institution
Return
this form to the American Dermatoglyphics Association
to:
Kathleen M. Fox, MHS, PhD
Strategic
Healthcare Solutions, LLC
P.O. Box 543
Monkton, MD 21111
email: kathyfox@comcast.net |
