Membership Application

Institution Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Institution Phone Number *

(###)

###

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Institution Type *

Public

Private

Institution Type *

2 Year

4 Year

Secondary School

Non-Profit? *

Yes

No

Voting Representative Contact Name *

First Name

Last Name

Voting Representative Contact Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Voting Representative Contact Phone *

(###)

###

####

Alternative Representative Contact Name

First Name

Last Name

Alternative Representative Contact Phone

(###)

###

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Will a representative be available for monthly membership conference calls (currently the 3rd Thursday of every month at 12:00 PM EST)? *

Yes

No

Will a representative attend the Study Florida Annual Meeting (3rd Thursday in May) at the institution's expense? *

Yes

No