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Name:
Email:
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Membership Category:
New Member $85.00
Renewal in Iowa Chapter $80.00
Student Membership (Full-Time Student) $25
Current Member
Title:
Company:
Work Street:
Work Box/Suite:
Work City:
Work State:
Work Zip:
Work Phone:
Work Fax:
Work Email:
Home Street:
Home Box/Apt:
Home City:
Home State:
Home Zip:
Primary Phone:
Home Fax:
Home Email:
Mail chapter information to::
Work
Home
Address to list in the directory:
Work
Home
Publish my home phone number?:
Yes
No
Publish my email address?:
Yes
No
Job Description:
Business Partner
Classroom Facilitator
HR Generalist
Instructional Designer
Learning Strategist
Training Manager/Director/VP
Project Manager
Performance Consultant
Other
Gender:
Male
Female
Education Level:
H. S.
A. A.
Bachelors
Masters
Specialist
Ph. D.
Size of Organization:
< 25
26 - 100
101 - 500
501 - 1,000
1,000+
Age:
<25
25 - 30
31 - 40
41 - 50
>50
Years in Training and/or HR Development:
1 - 3
4 - 7
8 - 10
11 - 15
16+
Organization Type:
Internal Resource (Work for a company or corporation)
External Resource (Independent Consultant)
National ASTD Member:
No
Yes
If Yes, Since:
Are you a member of another professional organization? if so which one(s)?:
Who were you referred by?:
Directory Resource Guide Listing (Please Choose 5):
Adult Education
HR Management
Project Management
Assessment Tools
Finance/Banking
Sales Training
Business Management
Humor/Fun
Talent Management
Career Planning & Development
Instructional Design
Team Building
Coaching (Executive)
Knowledge Management
Technical Writing/Training
Communication Skills
Leadership/Mgmt Dev
Training Delivery, Design, Evaluation & Measurement
Computer/Software Skills
Managing the Learning Function
Web Applications/Training
Conflict Management
Needs Analysis
Workplace Violence
Collaborative Learning
Online Learning
Other
Curriculum Development
Organization Development
Customer Service
Performance Consulting
EEO/AA/Diversity/Harassment
Presentation Skills
