
To apply for or renew your membership in the Association, print out and fill in this form and send it, along with your check or money order, to the following address:
Institution___________________________Department_____________________________
Mailing Address Line 1_______________________________________________________
Mailing Address Line 2_______________________________________________________
Mailing Address Line 3 ______________________________________________________
Mailing Address Line 4_______________________________________________________
City_____________________State______Postal Code__________Country_____________
Work Phone_______________________________FAX_________________________________
E-mail_____________________________Home Phone________________________________
Title____________________Highest Degree_________From_________________________
Primary Discipline___________________________________________________________
Do you wish to be listed in our on-line directory?
____Yes ____No
(No means that none of the information you provide
will be published in the directory.)
Nature of Appointment:
____Administration ____Direct Service ____Research ____Teaching ____Student
______________________Other
Age Groups of Interest:
____Children ____Adolescents ____Young Adults ____Adults ____Aged
Do you have expertise with any of the following minority or special populations:
____Minorities (gen) ____Suburban ____Physically challenged
____Asian/American ____Rural ____Disadvantaged/Poor ____African/American
____Girls/Women ____Urban ____Hispanics ____Boys/Men __________________Other
Major interest areas. (Check as many as apply.)
____Gender ____Peers ____Counseling ____Workplace ____Problem Behavior
____Schools ____Religion ____Drug use ____Higher Education ____Family
____Professions ______________________Other
Other Professional Memberships:
____SRCD ____AERA ____SRA ____APA _____________________________________Other
Type of Membership: ____Student ($60.00) ____Paying
Member ($75.00)
(Please note that the annual dues now include a special
subscription rate for the JOURNAL OF MORAL EDUCATION.)
Donation to the Kohlberg Memorial Lecture Endowment: $_______________________
Please note any suggestions or ways you wish to be come involved. Thank you for joining the Association and for your continued membership.