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To apply, print and complete this form and fax to: 301.907.2864, ATTN: Membership Department
Or, mail to: AFP P.O. Box 64714 Baltimore, MD 21264
For AFP Use Only CT12 ____________ Date ____________ CS Dept _________
Please TYPE or PRINT.
Name: ____________________________________________________________
Address: __________________________________________________________
City, State, Zip Code: ________________________________________________
Phone: _________________________ Fax: ___________________________
E-mail: ____________________________________________________________
Membership ID#: _______________
Name of most recent employer: ________________________________________
Last date of employment: ____________________________
I AM APPLYING FOR (please check all that apply):
DUES SUSPENSION AFP ANNUAL CONFERENCE SCHOLARSHIP*
*NOTE: If a Career Trust member becomes re-employed prior to using the scholarship, its award will be at AFP's discretion.
Have you ever been an AFP Volunteer? If so, list all volunteer roles and terms in which you have served. [List on separate sheet(s).]
I affirm that all the information I have stated is true. I understand that membership is conditional upon the qualifications outlined by the Career Trust program. I understand that the information I have listed above is subject to verification by AFP. If I become re-employed within the calendar year of my dues suspension I agree to remit dues to AFP for the membership year.
Signature: __________________________________ Date: _______________