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* Note: All fields with an asterisk in their label are required fields.

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Your User Information

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Email*

Password*

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Your Member Profile Information

Name*

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Primary Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add an Alternate/Home Address

I would like to add an alternate/home address

Alternate/Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credentials

Company/Institution

Phone - Work*

Phone - Personal

Area of Specialization

I would like to become more involved in APOSW

I want to become more involved in APOSW

My Interests

Joining an ongoing committee or Board of Directors

Becoming an abstract, social worker of the year or scholarship application reviewer

Writing for the newsletter or website

Helping at the annual conference as a SIG facilitator and/or session monitor

Gender*

Ethnicity*

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Membership Information

Membership Type*

Member - Regular Special half-year pricing (expires 12/31/22)

Member - Regular (2 Years)

Member - Regular (3 Years)

Member - Associate

Member - Non-North American

Member - Student

Member - Retired

Membership Notes

Associate Member: Associate memberships are open to all non-social worker professionals who share in the APOSW mission.

Student: Students must supply proof of status at time of application. Send email to membership@aposw.org

Membership Transferability: APOSW memberships are non-transferable and are valid from the submission date of this form through the end of your membership year. APOSW Membership must be renewed annually to receive uninterrupted member benefits.

Payment Information

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Payment Method

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Please Note: If you pay by check, your membership will be activated when the check has been received and deposited.

Make check payable to: APOSW

Mail payment to:
Mary Laliberte
Connecticut Children's Medical Center
Suite 5A
282 Washington St
Hartford, CT 06106

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