National Society of Black Physicists


Membership Application

 
Section 1: Member Information
 Salutation  
 First Name*  
 Initials  
 Last Name*  
 Gender*
Male
Female
 
 User Name*  
 Password*
confirm password 		 
 Institution/Company*  
 Classification/Job Title     
 Department  
 Address*  
 Address 2  
 City*  
 State*  
 Zip Code*  
 Country*  
 Address Type*  
 Work Phone  
 Home Phone  
 Cell Phone  
 Cell Phone Company  
 Fax  
 E-mail*  
 E-mail 2  
 Web Site  
 
Section 2: Additional Addresses
 Same as Primary Address    
 Address  
 Address 2  
 City  
 State  
 Zip Code  
 Country  
 Address Type  
 
Section 3: Education History
 Enter your Education History*
 
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
 
Section 4: Subscribe to Groups
 Subscribe to groups*
Acoustics (ACOU)
Astronomy and Astrophysics (ASTRO)
Atomic, Molecular and Optical Physics (AMO)
Chemical and Biological Physics (CBP)
Condensed Matter and Materials Physics (CMMP)
Cosmology, Gravitation, and Relativity (CGR)
Earth and Planetary Systems Science (EPSS)
Fluid and Plasma Physics (FPP)
Health Physics (HEA)
History, Policy and Education (HPE)
Mathematical and Computational Physics (MCP)
Medical Physics (MED)
Nuclear and Particle Physics (NPP)
Photonics and Optics (POP)
Physics Education Research (PER)
Technology Transfer, Business Development and Entrepreneurism (TBE)
 
 
Section 5: Membership Type
 Membership Type*
 $85.00 - Professional - Faculty, Staff, Industry
$30.00 - Postdoc
$20.00 - Graduate Student
$10.00 - Undergraduate Student
 
 
Section 6: Payment
 Payment Method*
    Credit card
 
 

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