Membership Form

(Alternatively, here is a PDF version that can be downloaded, printed and mailed if so desired.)

Thank you for your interest in ALPhA. Membership contributions for 2011 are $20. To join or to renew your membership in ALPhA, please fill out the form below. You may contribute with a credit or debit card, Paypal, a check, or by being invoiced—details below.

Personal Information

Salutation (Prof., Dr., etc.)

First Name

Last Name

Affiliated Institution

Department

Institution Address

City

State or Province

Zip Code

Country

Area Code and Phone Number

Your E-Mail Address

Your E-Mail Address (again)

Your Relationship with ALPhA

I am already a member of ALPhA and am RENEWING my membership

Yes No

We would like to know what other organizations (APS, AAPT, OSA, PIRA, etc.) you belong to. Please specify, too, the divisions to which you belong if appropriate (e.g. APS/DAMOP, AAPT/Cheasapeake Section).

If you would like to help with initiatives to support advanced lab instruction, serve on a task force, and/or ad hoc committee, please so indicate in the box below. Feel free to specify in detail.

What activities/support/etc. would you like to see this association provide? Please be as general or specific as you would like.

Payment Information

When you click on the submit button below, you will be taken to an acknowledgement page. From there you may choose your mode of payment. The choices are:

Credit Card: Click on the "Pay Now" button on acknowledgement page; this takes you to a secure Paypal-managed webpage. On the Paypal webpage, choose "Pay with debit or credit card," and follow the instructions thereafter.
Paypal: Click on the "Pay Now" button, but this time choose to "Log in to my Paypal account" and follow the instructions thereafter.
Check: Ignore the "Pay Now" button and instead write a check for $20 USD, made payable to “ALPhA”, and mail it to the ALPhA Treasurer.
Invoice: If you wish to be invoiced, indicate on the form below that you wish to be invoiced for your contribution. Be sure to click the submit button below. The Treasurer will contact you with an invoice.

I am paying with a credit card (Mastercard/VISA/AmExpress/Discover) or Paypal
I am mailing you a check
I wish to be invoiced for my membership contribution