SSME Membership Application

If you are applying as a new member, please complete Sections A and B below. If you are renewing your membership, complete only Section A.

Section A: Name and Contact Information
Name First Last
Date / MM / DD YYYY
Institution
Address of Institution
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Office Phone - (###) - ### ####
Fax - (###) - ### ####
Email
Home Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
All correspondence is sent to the office address. If you would prefer to have SSME materials sent to your home address, check here: Send to home address
Section B: Academic Training
Do you hold a Ph.D.? Yes No
If yes, year granted:
Institution:
Highest earned degree if not a Ph.D.:
Field:
Institution:
If you are a student:
Are you enrolled in a doctoral program in ethics and/or related fields? Yes No
Institution
Have you passed all examinations preliminary to writing the dissertation? Yes No
How did you learn about the Society? (Check all that apply) Colleague/Professor Website Mailing Other
Other:
Type the letters you see in the image below.