Cheiron Online: Membership

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CHEIRON,
named after the wise centaur of Greek myth, was formed in October 1968 to promote the international cooperation and multidisciplinarystudies in the history of behavioral and social sciences

- MEMBERSHIP APPLICATION FORM -

Please print off this page and fill out the appropriate fields and then send it to the address provided at the end.

Name: ___________________________________________________________________________

Preferred Mailing Address:
______________________________________________________
__________________________________
__________________________________

Office Telephone: ( ) _____________

Home Telephone: ( ) _____________

E-Mail Address; ______________________

Fax: ______________________________

Title: _____________________________

Institutional Affiliation: __________________________

Areas of historical interest: ________________________________________________________

Send check or money order for $35 US ($10 US for students) to:

David Devonis
Department of Psychology
Graceland University
1 University Place
Lamoni, IA 50140
USA