Association of Pan African Doctoral Scholars (APADS)
Membership Application

Post Office Box 19728 • Los Angeles, CA 90019
Email
: apads@verizon.net
Internet: http://www.apads.org
Info
: (323) 737-0841
Membership: (562) 434-9591

Please indicate your preferred address for communications by placing an asterisk alongside the relevant address, otherwise your home address will be used. Please print.

Name ________________________________

Present Address _______________________

_____________________________________

_____________________________________

City State ____________________________

Zip Code _____________________________

Telephone No _________________________

Fax _________________________________

EMail ________________________________

Website: www. ________________________

Name ________________________________

Home Address (if different) ______________

_____________________________________

_____________________________________

City State ____________________________

Zip Code _____________________________

Telephone No _________________________

Fax _________________________________

EMail ________________________________

Website: www. ________________________


The following information will be used in supporting marketing efforts of the organization and in connecting you with APADS members and associates.

Company or Institution Name ___________________________________________________

Office Address _______________________________________________________________

City, State, Zip Code __________________________________________________________

Office Phone (include area code) ________________________________________________

Office Fax (include area code) __________________________________________________

EMail Website Address (if any) __________________________________________________


Doctoral Degree (Ed.D., Ph.D., etc.) ______________________________________________

Doctoral Degree Emphasis _______________________________________________________

Institution ____________________________________________________________________

Dissertation Title ______________________________________________________________

Year Graduated or Expected Graduation ___________________________________________

Additional Higher Education Degrees
______________________________________________

Degree Awarded (B.A., B.S., M.A., M.B.A., etc.) and Concentration ____________________

Institution Attended ___________________________________________________________

Year Graduated _______________________________________________________________



Publications
Please tell us about your publications in the last ten years. You may attach an additional sheet if necessary.
YEAR TITLE OF ARTICLE OR BOOK NAME OF PUBLISHER___________________________________



Area(s) of Expertise
Please state areas in which you are available to serve as a resource for seminars, workshops or networking events:
Please indicate your interest in assisting in the following areas:

Research Methods   Dissertation Editing
Mentoring   Publicity
Website Development/Maintenance Journal Publication
 
Fundraising and Grant Writing Special Events and Programming
 

Signature __________________________________________ Date __________________