AAHEA Membership Application

Your Premier Higher Education Organization Since 1870!

Membership

Online Membership Application

Questions? Call 202-293-6440 or 1-888-276-1299 email: admin@AAHEA.org

Title:	Dr. Mrs. Ms. Mr. *
Name:	*
Title Discipline (if faculty) / office (if admin):	*
Organization/Institution:	*
Address:	*
City:	*
State or Province:	*
Zip:	*
Country:	*
Phone:	*
Membership and certificate is to be in the name of
Email:	*

Membership Dues

Please choose one *

1 year $99.00
2 years $175.00
3 years $250.00

Lifetime $1,000.00
Retired 1 year $70.00
Full time Student 1 year $55.00

Payment Method:	MasterCard Visa * American Express Discover
Credit Card Number:	*
Expiration Date:	mm/yy*
Name On Credit Card:	*
CVVS: Code	*
Statement Address:	*
City:	*
State:	*
Zip:	*
Amount to be charged or donated:	$ *

Please complete “Your AAHEA Demographic Profile” below.
You must complete it for AAHEA to process your membership.
AAHEA Membership Dues AAHEA’s membership year is Sep 1–Aug 31
All payments must be in US funds. For questions about your membership status, payment, benefits contact AAHEA

Your AAHEA Demographic Profile

Your Institution Type (Select one): *

Your Primary Position (Select one): *

President/Chancellor (01)	Information Technology Staff (14)
Chief Academic Officer (02)	Chief Business Officer (15)
Dean (03)	Business Staff (16)
Assoc/Asst. Academic Officer (04)	Graduate Student (17)
Department Chair (05)	Retired/Emeritus/Emerita (18)
FT Faculty Member (06)	CEO/Dir. Educ. Organization (19)
PT/Adjunct Faculty Member (07)	Staff, Educ. Organization (20)
VP/Dean/Dir. Student Affairs (08)	Director, Government Agency (21)
Staff, Student Affairs (09)	Staff, Government Agency (22)
VP/Dir. Institutional Research (10)	Director, Foundation (23)
Staff, Institutional Research (11)	Staff, Foundation (24)
Minority Affairs Officers/Staff (12)	Other (99)
Chief Information Officer (13)

Your Primary Discipline (Select one): *

Your Interest in Selected AAHEA Issues (Select the most appropriate): *

Academic Affairs/Student Affairs (01)	Faculty Roles & Rewards (09)
Assessment (02)	Graduate Students (10)
Civic Engagement (03)	Innovative Pedagogies (11)
Collaborative Learning (04)	Learning Communities (12)
Community Colleges (05)	Research on Higher Education (13)
Diversity (06)	Scholarship of Teaching & Learning (14)
Educational Use of Technology (07)	Service-Learning (15)
Faculty Governance (08)	Teaching and Learning (16)
	Other (99)

Optional (for each item check only one):

Gender:	Male Female
Age:	under 25 (01) 26-35 (02) 36-49 (03) 50-59 (04) 60 and up (05)
Ethnicity/Race:	American Indian/Alaska Native (01) White, Non-Hispanic (03) Hispanic (05) Black/African-American (02) Asian/Pacific Islander (04) Other (99)
Comments:

* Required