INTERNATIONAL TEST AND EVALUATION ASSOCIATION

APPLICATION FOR MEMBERSHIP

Date _____________________________

Name ___________________________________________________________________________________

____Mr. ____Mrs. ____Ms. ____Miss ____Dr. ____Other

Preferred Mailing Address ____Work ____Home

Company/Organization _____________________________________________________________________

Title ____________________________________________________________________________________

Street ___________________________________________________________________________________

City _________________ State _________ Zip _____________________ Country ___________________

Office Tel (Country Code + Area Code) ________________________________________________________

FAX Number (Country Code + Area Code) _____________________________________________________

E-mail __________________________________________________________________________________

Company/Organization World Wide Web URL (if applicable) ______________________________________

Home Address: ___________________________________________________________________________

________________________________________________________________________________________

Home Telephone (Country Code + Area Code) __________________________________________________

____Industry ____Military ____Government ____Academia

ITEA membership dues are $45 for individuals and $20 for full-time students.

Overseas addresses require additional $20 for postage.

Annual dues include a one-year subscription to The ITEA Journal of Test and Evaluation.

____Check payable in U.S. dollars to: International Test and Evaluation Association

____Credit Card (Circle One)

Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date __________________

Signature___________________________________________________ Date _________________________