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Armenian Professional Society
Organized in 1958 for The Advancement of Fellowship & Education
MEMBERSHIP APPLICATION
INSTRUCTIONS:
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Print out this form (we suggest printing in portrait format);
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Please read the membership requirements on the membership page;
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Please type or print.
Name__________________________________________________________________________
(Last) (First) (Middle)
Home Address
________________________________________________________________________________
(Street) (City) (State) (Zip)
Home Phone _________________________________________________________________
(Area Code) (Number)
Home e-mail __________________________________________________________________
Business Address
______________________________________________________________________________
(Street) (City) (State) (Zip)
Business Phone ___ ___________________________________________________________
(Area Code) (Number)
Business e-mail ______________________________________________________________
Birthplace ________________________________ Date _________________
(City & State) or (City & Country) (mo/day/yr)
Marital Status Married/Single ______________________
Spouse’s Name ________________________________________________________________
Number of children ______________ Ages ________________________
University or College ___________________________________________________________
Degree Completed ____________________________________________________________
Major ________________________________________________ Year ______________
Present Profession _____________________________________________________________
Specialty ______________________________________________________________________
Number of Years in Profession _________________________________________________
Name of Firm or Employer _____________________________________________________
Certificate or License _________________________________________________________
Other Professional Societies
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Social - Cultural - Compatriotic Societies (list)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Hobbies and/or Sports (list)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I have read the membership requirements and answered all the requested information (above). My two sponsors are listed on the bottom of this application.
Date ______________________ Signed ________________________________________
(Please enclose check for one year membership dues of $95)
Mail To:
Armenian Professional Society
P. O. Box 1944
Glendale, CA 91209-1944
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We believe the candidate _______________________________________ qualifies for membership into the Armenian Professional Society and has our endorsement:
Sponsor (1) __________________________________________________________________
APS member (Print name) (Signature)
Sponsor (2) __________________________________________________________________
APS member (Print Name) (Signature)
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