MESA Membership Update

What would you like to do?

A. Update membership record (dues already paid): Complete form below.

B. Update membership record AND pay dues: Please go here.

C. Join MESA as a first-time member: Please go here.

For members simply updating their record, please only complete information that has changed, but you must complete the Last Name and First Name & MI fields (so we know who you are!). If you need to check the data MESA has on file for you, locate your record in the membership directory.

Items marked with a * will appear in the Roster of Members (published in even years only). Items marked with a # are gathered for statistical purposes only and are optional. If you have problems with this form, please contact Sara Palmer at palmers@email.arizona.edu

General Information

*Last Name (REQUIRED)
First Name & MI (REQUIRED)
Affiliation/Institution
Position
Specific Title of Position (if relevant; i.e. "Endowed Chair of...")

Membership Directory Address (for online membership directory and printed Roster of Members)

*Department
*Institution or Business
*Business Street Address
*City
*State
*Postal Code
*Country

Mailing Address If mailing address is the same as above, please check here. Otherwise, please provide the mailing address where you would like to receive your MESA pubications and other correspondence.

Street 1
Street 2
Street 3
City
State
Postal Code
Country


*Work Phone		Publish? yes no
*Home Phone		Publish? yes no
*Cell Phone		Publish? yes no
*Fax Number		Publish? yes no
*E-mail		Publish? yes no
#Gender	Male Female
#Ethnicity
#Date of Birth
#Country of Birth
#Country of Residence
#Country of Citizenship

*Title/Occupation

*Education

Please list the degrees you have received, with the highest degree listed first.

Degree	Year Granted	Granting Institution	Granting Department

*Discipline (select one)

*Sub-Areas (select up to five)

Choice #1

Choice #2

Choice #3

Choice # 4

Choice #5

*Specialties (indicate your main specialties and research interests. List no more than three and be concise - max. of 45 characters)

1.
2.
3.

*Geographical Areas of Interest (select up to three)

Choice #1	Choice #2	Choice #3

*Languages check the skill level next to the appropriate language: Elementary-E, Intermediate-I, Advanced-A, Fluent-F, Native-N)

	E	I	A	F	N
Arabic
Armenian
Assyrian
Azeri
Chinese
French
German
Greek
Hebrew
Japanese
Kazakh
Kurdish
Kyrgyz
Pashto
Persian
Russian
Spanish
Tajik
Turkish
Uzbek
Other
Other

Message to Membership Coordinator