Hawai‘i Educational Research Association

Membership Application


Calendar Year: ______________________________

Name: _________________________________________________________________

Job Title (if professional): __________________________________________________

Organization: ___________________________________________________________

Business Street Address: __________________________________________________

Business City, State, ZIP: __________________________________________________

Campus Address (if UHM): ________________________________________________

Home Street Address: _____________________________________________________

Home City, State, ZIP: _____________________________________________________

If needed, where would you like your HERA mail sent? __ Home __ Business

Phones: Business: ______________ Home: _______________ Fax: ________________

E-mail Address: __________________________________________________________

Dues: __ Professional $15 __ Full-time Student $10

 

Total Amount Enclosed: $ _____________

Purchase Orders are welcome. For more information call Lauren Mark 956-6369 or Truc Nguyen 956-6507 or email herainfo@hawaii.edu.

Please make check payable to HERA and send this form and check to

HERA, Attn: Membership Committee
c/o Department of Educational Psychology
University of Hawai‘i, 1776 University Ave, Wist Hall 214, Honolulu, HI 96822