THE
PAVLOVIAN SOCIETY
For the Objective Study of Behavior
Founded
1955
by W. Horsley Gantt
APPLICATION
FOR MEMBERSHIP
NAME______________________________________________________________________________
Last
First
Middle Initial
MAILING
ADDRESS
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
PHONE
____________________________FAX ____________________________________________
E-MAIL
_____________________________________________________________________________
Highest
Degree __________
Year_________________________________________________________________
Major
Minor
University____________________________________________________________________________________
Primary
Professional
Training___________________________________________________________________
Present
Position______________________________ Name of
Institution________________________________
Address
(if different from
above)_________________________________________________________________
_____________________________________________________________________________________________
Specific
Research/Work
Areas___________________________________________________________________
Primary
Professional
Interests___________________________________________________________________
Signature
of Applicant:
________________________________________________ Date__________________
Regular
Membership & Post-docs: $30.00
__________
Student Membership: $20.00
Pay dues online at the home page (www.pavlovian.org) or include check or money order when you send your application form.
Mail,
email, or fax completed application to:
W.
Jeffrey Wilson
Secretary/Treasurer Pavlovian Society
Department of Psychology
Albion
College
611 E. Porter St.
Albion,
MI 49224
Email:
wjwilson@albion.edu
FAX: 517-629-0407